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Pancreatic Neuroendocrine Tumors (pNETs)

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Surgical Management of Elderly Patients

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Abstract

This chapter briefly summarizes the epidemiology, pathophysiology, clinical management, and outcomes of patients with pancreatic neuroendocrine tumors (PNETs) and highlights recent advances in PNET research. PNETs are rare neoplasms, compared with carcinomas arising from pancreatic exocrine tissue. They, like other neuroendocrine tumor types, display variable malignant potential, hormone-related syndromes (functionality), localization, and genetic background. Although tumor origin and molecular pathogenesis remain poorly understood, recently established grading and staging systems facilitate patient risk stratification and thereby directly impact clinical decision-making. Although the optimal clinical management of PNETs involves a multidisciplinary approach, surgery remains the only curative treatment for early-stage disease. Surgery may also have a role in patients with advanced stage disease, including those with hepatic metastases. Alternative therapeutic approaches applied to PNETs, including chemotherapy, radiofrequency ablation, transarterial chemoembolization, biotherapy, polypeptide radionuclide receptor therapy, antiangiogenic therapy, and selective internal radiotherapy, have failed to demonstrate a long-term survival benefit. Surgery remains the primary therapeutic option for patients with PNETs. Research on PNETs is desperately needed to improve the therapeutic options for patients with this disease.

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Authors and Affiliations

  1. Unit of Endocrine Surgery, Department of Surgical Sciences, School of Medicine University of Perugia, Azienda Ospedaliera “S. Maria, Via Tristano di Joannuccio 1, 05100, Terni, Italy

    Alessandro Sanguinetti, Andrea Polistena & Nicola Avenia

  2. Department of Colorectal Surgery, University Hospital of Malmoe-Lund, SUS, Lund, Sweden

    Louis Banka Johnson

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  1. Department of General and Mininvasive Surgery, Cristo Re Hospital, Rome, Italy

    Antonio Crucitti

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Sanguinetti, A., Polistena, A., Johnson, L.B., Avenia, N. (2018). Pancreatic Neuroendocrine Tumors (pNETs). In: Crucitti, A. (eds) Surgical Management of Elderly Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-60861-7_9

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