SURGICAL MANAGEMENT OF NON-FUNCTIONING PANCREATIC NEUROENDOCRINE TUMORS: NARRATIVE REVIEW

Abstract

Neuroendocrine tumors (NETs) consist of a heterogeneous group of neoplasms with multiple clinical and biological manifestations. Pancreatic NETs (PNETs) are among the most common types of NETs. Functional NETs typically cause hyperfunctional syndromes such as insulinomas, VIPomas, glucagonomas, and gastrinomas. The majority of TNEPs, however, do not present these clinical findings and are categorized as non-functioning, producing no symptoms until a significant tumor mass is reached. Most commonly, non-functioning TNEPs (NF-TNEP) are discovered incidentally during the investigation of other conditions, making diagnosis a challenge, although the use of nuclear imaging is useful for detecting these tumors. Although functioning tumors have a clear indication for surgical treatment, there is still controversy regarding the appropriate treatment of NF-TNEP, considering their more insidious biology. One study reports controversy about the role of surgical resection of asymptomatic PTN ≤ 2cm as the first line of treatment, with some authors suggesting active surveillance as an alternative. However, a retrospective analysis found a higher mortality rate among the non-surgical treatment group compared to surgical treatment. TNEPs also have an unpredictable malignant potential, and benign findings on histopathology do not exclude the chance of tumor progression. Although there is still no consensus on the ideal management of PNES, the surgical approach is still the first choice, as some studies show greater benefits with this alternative. However, active surveillance is increasingly welcomed in the management of small tumors.