Surgical management of sporadic pancreatic neuroendocrine tumor

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  • 孤発性膵神経内分泌腫瘍の外科的治療

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論文(Article)

Recently, new treatment guidelines and classifications were proposed for the management of pancreatic neuroendocrine tumors（P-NETs）, and are now being used in clinical practice. The World Health Organization classification published in 2010 emphasized the importance of a grading system for P-NETs based on parameters of proliferative activity, such as mitotic count and Ki-67 labeling index, proposed by the European Neuroendocrine Tumor Society. For surgical treatment of P-NETs, it is important to select a strategy based on the degree of tumor malignancy. However, there are still no clear indications for organ-preserving pancreatic resection or lymph node dissection. This article outlines the surgical management and clinicopathological features of P-NETs. There are various surgical options, such as tumor enucleation, spleen-preserving distal pancreatectomy（SpDP），distal pancreatectomy with splenectomy, pancreatoduodenectomy, and duodenumpreserving pancreatic head resection. Hepatectomy is the first choice for liver metastasis from welldifferentiated neuroendocrine carcinoma without extrahepatic metastasis. Other treatment options are radiofrequency ablation, transarterial chemoembolization/ embolization, and liver transplantation. Systematic chemotherapy, biotherapy such as somatostatin analogue and interferon-α, and targeted therapy are used for recurrence after surgery and unresectable tumors. This article also gives details of the surgical techniques available for tumor enucleation and SpDP.

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