Surgical management of non-functioning pancreatic neuroendocrine tumors

Abstract

The incidence of pancreatic neuroendocrine tumors is increasing and the ratio of non-functioning tumors is gradually increasing due to progress in imaging technology. The definition of a non-functioning PNET is a tumor which presents without symptoms. These are potentially malignant and treatment is recommended according to size. The first choice for the treatment of a non-functioning pancreatic neuroendocrine tumor is resection. Localized, small, malignant non-functioning PNETs should be aggressively resected, while for small benign-appearing tumors the risks and the benefits of surgery should be carefully weighed. The surgical resection of liver metastases from non-functioning PNETs should be recommended if complete resection is possible. However, the benefit of surgical resection is limited compared to intra-arterial therapy if the tumor burden is high.