Surgical management of pancreatic neuroendocrine tumors

PNET: pancreatic neuroendocrine tumor.
* PNETs associated with multiple endocrine neoplasia or Zollinger-Ellison syndrome are managed differently.
¶ Rarely, localized primary tumor will be unresectable (eg, directly invading the celiac plexus).
Δ Based on evidence of local invasion, regional lymphadenopathy, metastases.
◊ Includes: long-acting somatostatin analogs, proton pump inhibitors (gastrinoma), diazoxide (insulinoma).
§ Observation rather than initial resection is an option for small (<2 cm) localized nonprogressing tumors that are well-differentiated, and low grade (Ki67 <2%)​.