Detailed Abstract
[BP Symposium 3 - Current Issues of PNET]
[BP SY 3-2] How to manage the small, nonfunctional PNET?
In Woong Han
Sungkyunkwan University, Korea
Most PNETs occur as sporadic tumors, between 60% and 90% of PNETs are non-functional, which are generally diagnosed at more advanced stages because of their relatively indolent nature and slow growth causing a delay in onset of symptoms. However, there is also an exponential increase of incidental diagnoses of NF-PNETs which are becoming frequent with the widespread use of high-quality imaging techniques.
The surgical management of small size (≤2cm) NF-PNET is not unanimous according to several guidelines. According to NCCN guideline 2017 version 3 and NANET consensus guideline 2013, every NF-PNET, including less than 2cm sized tumor, should be resected except some patients who are not suitable for surgery, such as high surgical risk or life-threatening morbidities. However, ENET guideline 2016 recommended that a conservative approach seems to be safe as the majority of the observed tumors did not show any significant changes during follow-up.
Parenchymal-sparing resection, such as enucleation, central pancreatectomy, or duodenum-preserving pancreatic head resection, is also debatable as surgical resection compared to standard resection including pancreatoduodenectomy, and distal pancreatectomy. No present guidelines have recommended appropriate surgical extent for parenchymal resection. Considering oncologic safety and quality of life, this question should be discussed.
ENET guideline 2016 suggested that the presence of lymph node metastases, in case of small NF-PNET, as a prognostic factor has been unclear with different studies giving different results. However, NCCN guideline 2017 version 3 and NANET consensus guideline 2013 recommended routine lymph node dissection should be performed, even small size NF-PNET, for risk of lymph node metastases.
As a result, this symposium will discuss for small sized NF-PNET to perform surgery or not, to perform standard resection or not, and to perform lymph node dissection or not.
References
- Neuroendocrine tumors, NCCN Clinical Practice Guidelines in Oncology. version 3. 2017
- M Falconia et al, Consensus guidelines update for the management of functional p-NETs (F-p-NETs) and non-functional p-NETs (NF-p-NETs). Neuroendocrinology. 2016 ; 103(2): 153–171
- Pamela L. Kunz et al, Consensus Guidelines for the Management and Treatment of Neuroendocrine Tumors. Pancreas 2013;42: 557-577
The surgical management of small size (≤2cm) NF-PNET is not unanimous according to several guidelines. According to NCCN guideline 2017 version 3 and NANET consensus guideline 2013, every NF-PNET, including less than 2cm sized tumor, should be resected except some patients who are not suitable for surgery, such as high surgical risk or life-threatening morbidities. However, ENET guideline 2016 recommended that a conservative approach seems to be safe as the majority of the observed tumors did not show any significant changes during follow-up.
Parenchymal-sparing resection, such as enucleation, central pancreatectomy, or duodenum-preserving pancreatic head resection, is also debatable as surgical resection compared to standard resection including pancreatoduodenectomy, and distal pancreatectomy. No present guidelines have recommended appropriate surgical extent for parenchymal resection. Considering oncologic safety and quality of life, this question should be discussed.
ENET guideline 2016 suggested that the presence of lymph node metastases, in case of small NF-PNET, as a prognostic factor has been unclear with different studies giving different results. However, NCCN guideline 2017 version 3 and NANET consensus guideline 2013 recommended routine lymph node dissection should be performed, even small size NF-PNET, for risk of lymph node metastases.
As a result, this symposium will discuss for small sized NF-PNET to perform surgery or not, to perform standard resection or not, and to perform lymph node dissection or not.
References
- Neuroendocrine tumors, NCCN Clinical Practice Guidelines in Oncology. version 3. 2017
- M Falconia et al, Consensus guidelines update for the management of functional p-NETs (F-p-NETs) and non-functional p-NETs (NF-p-NETs). Neuroendocrinology. 2016 ; 103(2): 153–171
- Pamela L. Kunz et al, Consensus Guidelines for the Management and Treatment of Neuroendocrine Tumors. Pancreas 2013;42: 557-577
SESSION
BP Symposium 3
Room A 3/31/2018 8:50 AM - 9:10 AM