Surgical management of localized pancreatic neuroendocrine tumors

G: grade; MEN: multiple endocrine neoplasia; PNEC: pancreatic neuroendocrine carcinoma; PNET: pancreatic neuroendocrine tumor; VHL: von Hippel-Lindau.

* Familial PNETs associated with MEN or VHL disease are excluded from this algorithm. For surgical management of PNEC, refer to UpToDate content on poorly differentiated gastroenteropancreatic NEC.

¶ Endoscopic ultrasound-guided radiofrequency ablation is an emerging alternative to surgery for small, low-grade PNETs, especially in poor surgical candidates.

Δ The appropriateness of and exact criteria for enucleation or central pancreatectomy of PNET is controversial. Refer to UpToDate content on surgical resection of PNET for further details.