World Journal of Surgery

, Volume 28, Issue 12, pp 1248–1260 | Cite as

Surgery of Resectable Nonfunctioning Neuroendocrine Pancreatic Tumors

  • Henning Dralle
  • Sabine L. Krohn
  • Wolfram Karges
  • Bernhard O. Boehm
  • Michael Brauckhoff
  • Oliver Gimm


Nonfunctioning neuroendocrine pancreatic tumors (NFNEPTs) comprise about one-third of pancreatic endocrine tumors. Based on immunohistochemistry, nonfunctioning tumors are difficult to distinguish from functioning ones; therefore the final diagnosis is basically the result of a synopsis of pathology and clinical data. Owing to their incapacity to produce hormone-dependent symptoms, NFNEPTs are detected incidentally or because of uncharacteristic symptoms resulting from local or distant growth. About two-thirds of NFNEPTs are located in the pancreatic head, so jaundice may be a late symptom of this tumor. Modern diagnostic procedures are best applied by a stepwise approach: first endoscopic ultrasonography and computed tomography/magnetic resonance imaging followed by somatostatin receptor scintigraphy or positron emission tomography (or both). Due to significant false-positive and false-negative findings, for decision-making the latter should be confirmed by a second imaging modality. Regarding indications for surgery and the surgical approach to the pancreas, three pancreatic manifestations of NFNEPTs can be distinguished: (1) solitary benign non-multiple endocrine neoplasia type 1 (non-MEN-1); (2) multiple benign MEN-1; and (3) malignant NFNEPTs. Reviewing the literature and including our experience with 18 NFNEPTs (8 benign, 10 malignant) reported here, the following conclusions can be drawn: (1) Solitary benign non-MEN-1 NFNEPTs can be removed by enucleation or by pancreas-, spleen-, and duodenum-preserving techniques in most cases. The choice of surgical technique depends on the location and site of the tumor and its anatomic relation to the pancreatic duct. (2) With multiple benign MEN-1 NFNEPTs, because of the characteristics of the underlying disease a preferred, more conservative concept (removal of only macrolesions) competes with a more radical procedure (left pancreatic resection with enucleation of head macrolesions). Further studies are necessary to clarify the best way to balance quality of life (by preserving organ function) with growth control of potentially malignant tumors in the pancreas. (3) Malignant NFNEPTs comprise more than half of all NFNEPTs. Few studies have analyzed treatment strategies for localized or metastatic tumors. Whereas radical (including multivisceral) resection of tumors without distant metastases is widely accepted, the indication for radical surgery on metastasizing tumors has been questioned, as radical removal of the primary tumor may fail to increase survival. Adjuvant regimens in these tumor stages are mandatory and should be further optimized.


  1. 1.
    Eriksson B, Öberg K. PPomas and nonfunctioning endocrine pancreatic tumors: clinical presentation, diagnosis, and advances in management. In Mignon M, Jensen RT, editors, Endocrine tumors of the pancreas, Frontiers in Gastrointestinal Research, vol. 23, Basel, Karger, 1995;208–222Google Scholar
  2. 2.
    Hochwald SN, Conlon KC, Brennan MF. Nonfunctioning pancreatic islet all tumors. In Doherty GM, Skogseid B, editors, Surgical Endocrinology, Philadelphia, Lippincott, 2001;361–373Google Scholar
  3. 3.
    Cheslyn-Curtis, S, Sitaram, V, Williamson, RCN 1993Management of non-functioning neuro-endocrine tumors of the pancreasBr. J. Surg.80625627PubMedGoogle Scholar
  4. 4.
    Heitz, PU, Kasper, M, Polak, JM,  et al. 1982Pancreatic endocrine tumorsHum. Pathol.13263271PubMedGoogle Scholar
  5. 5.
    Kimura, W, Kuroda, A, Morioka, Y 1991Clinical pathology of endocrine tumors of the pancreasDig. Dis. Sci.36933942PubMedGoogle Scholar
  6. 6.
    Lam, KY, Lo, CY 1997Pancreatic endocrine tumor: a 22-year clinicopathological experience with morphological, immunohistochemical observation and a review of the literatureEur. J. Surg. Oncol.233642PubMedGoogle Scholar
  7. 7.
    Madura, JA, Cummings, OW, Wiebke, EA,  et al. 1997Nonfunctioning islet cell tumors of the pancreas: a difficult diagnosis but one worth the effortAm. Surg.63573578PubMedGoogle Scholar
  8. 8.
    Broughan, TA, Leslie, JD, Soto, JM,  et al. 1986Pancreatic islet cell tumorsSurgery99671677PubMedGoogle Scholar
  9. 9.
    Dial, PF, Braasch, JW, Rossi, RL,  et al. 1985Management of nonfunctioning islet all tumors of the pancreasSurg. Clin. North Am.65291299PubMedGoogle Scholar
  10. 10.
    Eriksson, B, Arnberg, H, Lindgren, PG,  et al. 1990Neuroendocrine pancreatic tumors: clinical presentation, biochemical and histopathological findings in 84 patientsJ. Intern. Med.228103113PubMedGoogle Scholar
  11. 11.
    Kent, RB, Heerden, JA, Weiland, LH 1981Nonfunctioning islet all tumorsAnn. Surg.193185190PubMedGoogle Scholar
  12. 12.
    Klöppel, G, Heitz, PU 1988Pancreatic endocrine tumorsPathol. Res. Pract.183155168PubMedGoogle Scholar
  13. 13.
    Lo, CY, Heerden, JA, Thompson, GB,  et al. 1996Islet cell carcinoma of the pancreasWorld J. Surg.20878884CrossRefPubMedGoogle Scholar
  14. 14.
    Friesen, SR 1982Tumors of the endocrine pancreasN. Engl. J. Med.306580589PubMedGoogle Scholar
  15. 15.
    Thompson, NW, Lloyd, RV, Nishiyama, RH,  et al. 1984MEN 1 pancreas: a histological and immunohistochemical studyWorld J. Surg.8561574PubMedGoogle Scholar
  16. 16.
    Thompson, NW, Eckhauser, FE 1984Malignant islet cell tumours of the pancreasWorld J. Surg.8940951PubMedGoogle Scholar
  17. 17.
    Gossens A, Heitz P, Klöppel G. Pancreatic endocrine cells and their non-neoplastic proliferations. In Dayal Y, editor, Endocrine pathology of the gut and pancreas, Boca Raton, CRC Press, 1991;69–104Google Scholar
  18. 18.
    Rahier J. The diabetic pancreas: a pathologist’s view. In Lefèbvre PJ, Pipellers DG, editors, The pathology of the endocrine pancreas in diabetes, Berlin, Springer, 1988;17–40Google Scholar
  19. 19.
    Howard, TJ, Stabile, BL, Zinner, MJ,  et al. 1990Anatomic distribution of pancreatic endocrine tumorsAm. J. Surg.159258264PubMedGoogle Scholar
  20. 20.
    Eckhauser, FE, Cheung, PS, Vinik, AI,  et al. 1986Nonfunctioning malignant neuroendocrine tumors of the pancreasSurgery100978988PubMedGoogle Scholar
  21. 21.
    Bartsch, DK, Langer, P, Wild, A,  et al. 2000Pancreaticoduodenal endocrine tumors in multiple endocrine neoplasia type 1: surgery or surveillance?Surgery128958966CrossRefPubMedGoogle Scholar
  22. 22.
    Grama, D, Skoseid, B, Wilander, E,  et al. 1992Pancreatic tumors in multiple endocrine neoplasia type 1: clinical presentation and surgery treatmentWorld J. Surg.16611619PubMedGoogle Scholar
  23. 23.
    Skogseid, B, öberg, K, Eriksson, B,  et al. 1996Surgery for asymptomatic pancreatic lesion in multiple endocrine neoplasia type 1World J. Surg.20872877CrossRefPubMedGoogle Scholar
  24. 24.
    Libutti, SK, Chouyke, PL, Alexander, R,  et al. 2000Clinical and genetic analysis of patients with pancreatic neuroendocrine tumors associated with von Hippel-Lindau diseaseSurgery12810221028CrossRefPubMedGoogle Scholar
  25. 25.
    Shepherd, JJ 1991The natural history of MEN 1 which may be highly unrecognized rather than highly uncommonArch. Surg.126935952PubMedGoogle Scholar
  26. 26.
    Eriksson, B, öberg, K 1993An update of the medical treatment of malignant endocrine pancreatic tumorsActa Oncol.32203208PubMedGoogle Scholar
  27. 27.
    Eriksson, B, Bergström, M, Lilja, A,  et al. 1993Positron emission tomography (PET) in neuroendocrine gastrointestinal tumorsActa Oncol.32189196PubMedGoogle Scholar
  28. 28.
    Schindl, M, Kaczirek, K, Kaserer, K,  et al. 2000Is the new classification of neuroendocrine pancreatic tumors of clinical help?World J. Surg.2413121318CrossRefPubMedGoogle Scholar
  29. 29.
    Skogseid, B, Eriksson, B, Lundqvist, G,  et al. 1991Multiple endocrine neoplasia type 1: a 10 years prospective screening study in four kindredsJ. Clin. Endocrinol. Metab.73281287Google Scholar
  30. 30.
    Skogseid, B, öberg, K, Akerström, G,  et al. 1998Limited tumor involvement found at multiple endocrine neoplasia type 1 pancreatic exploration: can it be predicted by preoperative tumor localization?World J. Surg.22673678CrossRefPubMedGoogle Scholar
  31. 31.
    Lowney, JK, Frisella, MM, Lairmore, TC,  et al. 1999Pancreatic islet cell tumor metastasis in multiple endocrine neoplasia type 1: correlation with primary tumor sizeSurgery12510431049Google Scholar
  32. 32.
    Machens, A, Niccoli-Sire, P, Hoegel, J,  et al. 2003Early malignant progression of hereditary medullary thyroid cancerN. Engl. J. Med.34915171525CrossRefPubMedGoogle Scholar
  33. 33.
    Anderson, MA, Coopenter, S, Thompson, NW,  et al. 2000Endoscopic ultrasound is highly accurate and dissects management in patients with neuroendocrine tumors of the pancreasAm. J. Gastroenterol.9522712277PubMedGoogle Scholar
  34. 34.
    Proye, C, Malvaux, P, Pattou, F,  et al. 1998Noninvasive imaging of insulinomas and gastrinomas with endoscopic ultrasonography and somatostatin receptor scintigraphySurgery12411341144CrossRefPubMedGoogle Scholar
  35. 35.
    Kettritz, U, Semelka, RC 1996Contrast-enhanced MR imaging of the pancreasMagn. Reson. Imaging Clin. N. Am.487100PubMedGoogle Scholar
  36. 36.
    Stafford-Johnson, DB, Francis, IR, Eckhauser, FE,  et al. 1998Dual-phase helical CT of non-functioning islet cell tumorsJ. Comput. Assist. Tomogr.22335339CrossRefPubMedGoogle Scholar
  37. 37.
    Fidler, JL, Johnson, CD 2001Imaging of neuroendocrine tumors of the pancreasInt. J. Gastrointest. Cancer307385CrossRefPubMedGoogle Scholar
  38. 38.
    Semelka, RC, Custochi, CM, Bolci, NC,  et al. 2000Neuroendocrine tumors of the pancreas: spectrum of appearances on MRIJ. Magn. Reson. Imaging11141148CrossRefPubMedGoogle Scholar
  39. 39.
    Thoeni, RF, Mueller-Lisse, UG, Chan, R,  et al. 2000Detection of small, functional islet cell tumors in the pancreas: selection of MR imaging sequences for optimal sensitivityRadiology214483490PubMedGoogle Scholar
  40. 40.
    Catalano, C, Pavone, P, Laghi, A 1998Pancreatic adenocarcinoma: combination of MR imaging, MR angiography, MR cholangiopancreatography for the diagnosis and assessment of respectabilityEur. Radiol.8428434CrossRefPubMedGoogle Scholar
  41. 41.
    Hônninen, EL, Amthauer, H, Hosten, H,  et al. 2002Prospective evaluation of pancreatic tumors: accuracy of MR imaging with MR cholangiopancreatography and MR angiographyRadiology2243441PubMedGoogle Scholar
  42. 42.
    McFahrland, EG, Kaufman, JA, Saini, S,  et al. 1996Preoperative staging of cancer of the pancreas: value of MR angiography versus conventional angiography in detecting portal venous invasionAJR Am. J. Roentgenol.1663743PubMedGoogle Scholar
  43. 43.
    Hough, TJ, Raptoprulos, V, Siewert, B,  et al. 1999Teordrop superior mensenteric vein: CT sign for unresectable carcinoma of the pancreasAJR Am. J. Roentgenol.17315091512PubMedGoogle Scholar
  44. 44.
    Ichikawa, T, Haradome, H, Hachiya, J,  et al. 1997Pancreatic ductal adenocarcinoma: preoperative assessment with helical CT versus dynamic MC imagingRadiology202655662PubMedGoogle Scholar
  45. 45.
    Brigemti, V, Matteim, M, Ferri, P,  et al. 2001Octreoscan SPECT evaluation in the diagnosis of pancreas neuroendocrine tumorsCancer Biother. Radiopharm.16515524CrossRefPubMedGoogle Scholar
  46. 46.
    Yim, JH, Siegel, BA, Benedetti, MK,  et al. 1998Prospective study of the utility of somatostatin-receptor scintigraphy in the evaluation of patients with multiple endocrine neoplasia type 1Surgery12410371042CrossRefPubMedGoogle Scholar
  47. 47.
    Frilling, A, Malago, M, Martin, H,  et al. 1998Use of somatostatin receptor scintigraphy to image extrahepatic metastases of neuroendocrine tumorsSurgery12410001004CrossRefPubMedGoogle Scholar
  48. 48.
    Pasquali, C, Rubello, D, Sperti, C,  et al. 1998Neuroendocrine tumor imaging: can 18F-fluorodeoxyglucose positron emission tomography detect tumors with poor prognosis and aggressive behavior?World J. Surg.22588592CrossRefPubMedGoogle Scholar
  49. 49.
    Ahlström, H, Eriksson, B, Bergstrom, M,  et al. 1995Pancreatic neuroendocrine tumors: diagnosis with PETRadiology195333337PubMedGoogle Scholar
  50. 50.
    Eijck, CH, Laberts, SWJ, Lemaire, LCJM,  et al. 1996The use of somatostatin receptor scintigraphy in the differential diagnosis of pancreatic duct cancers and islet cell tumorsAnn. Surg.224119124CrossRefPubMedGoogle Scholar
  51. 51.
    Ginès, A, Vazquez-Sequeiros, E, Soria, MT,  et al. 2002Usefulness of EUS-guided fine needle aspiration (EUS-FNA) in the diagnosis of functioning neuroendocrine tumorsGastrointest. Endosc.56291296PubMedGoogle Scholar
  52. 52.
    Voss, M, Hammel, P, Molas, G,  et al. 2000Value of endoscopic ultrasound guided fine needle aspiration biopsy in the diagnosis of solid pancreatic massesGut46244249CrossRefPubMedGoogle Scholar
  53. 53.
    Collins, BT, Cramer, HM 1996Fine needle aspiration cytology of islet all tumorsCytopathology153745CrossRefGoogle Scholar
  54. 54.
    Karlson, BM, Forsman, CA, Wilander, E,  et al. 1996Efficiency of percutaneous case biopsy in pancreatic tumor diagnosisSurgery1207579PubMedGoogle Scholar
  55. 55.
    Labate, AM, Klimstra, DL, Zakowski, MF 1997Comparative cytologic features of pancreatic acinar cell carcinoma and islet cell tumorDiagn. Cytopathol.16112126CrossRefPubMedGoogle Scholar
  56. 56.
    Lee, CS 1996Lack of p53 immunoreactivity in pancreatic endocrine tumorsPathology28139141PubMedGoogle Scholar
  57. 57.
    Madeira, I, Terris, B, Voss, M,  et al. 1998Prognostic factors in patients with endocrine tumors of the duodenopancreatic areaGut43422427PubMedGoogle Scholar
  58. 58.
    White, TJ, Edney, JA, Toppson, JS,  et al. 1994Is there a prognostic difference between functional and nonfunctional islet cell tumorsAm. J. Surg.168627630PubMedGoogle Scholar
  59. 59.
    Rosa, S, Sessa, F, Capella, C,  et al. 1996Prognostic criteria non-functioning pancreatic endocrine tumorsVirchows Arch.429323333CrossRefPubMedGoogle Scholar
  60. 60.
    Muscarella, P, Melvin, WS, Fisher, WE,  et al. 1998Genetic alterations in gastrinomas and nonfunctioning pancreatic neuroendocrine tumors: an analysis of p16/MTS1 tumor suppressor gene inactivationCancer Res.58237240PubMedGoogle Scholar
  61. 61.
    Bartsch, D, Hahn, SA, Danichevski, KD,  et al. 1999Mutations of the DPC4/Smad4 gene in neuroendocrine pancreatic tumorsOncogene1823672371CrossRefPubMedGoogle Scholar
  62. 62.
    House, MG, Hermaux, JG, Cono, MZ,  et al. 2003Prognostic value of hMLH1 methylation and microsatellite instability in pancreatic endocrine neoplasmsSurgery134902909CrossRefPubMedGoogle Scholar
  63. 63.
    House, MG, Herman, JG, Cono, MZ,  et al. 2003Aberrant hypermethylation of tumor suppressor genes in pancreatic endocrine neoplasmsAnn. Surg.238423432PubMedGoogle Scholar
  64. 64.
    Chu, QD, Hill, HC, Douglass, HO,Jr,  et al. 2002Predictive factors associated with long-term survival in patients with neuroendocrine tumors of the pancreasAnn. Surg. Oncol.9855862PubMedGoogle Scholar
  65. 65.
    Hessman, O, Skogseid, B, Westin, G,  et al. 2001Multiple allelic deletions and intratumoral genetic heterogeneity in MEN 1 pancreatic tumorsJ. Clin. Endocrinol. Metab.8613551361Google Scholar
  66. 66.
    Asteria, C, Anagni, M, Fugazolla, L,  et al. 2002MEN 1 gene mutations are a rare event in patients with sporadic neuroendocrine tumorsEur. J. Intern. Med.13319323CrossRefPubMedGoogle Scholar
  67. 67.
    Fernandez-Cruz, L, Sáenz, A, Astudillo, E,  et al. 2002Outcome of laparoscopic pancreatic surgery: endocrine and nonendocrine tumorsWorld J. Surg.2610571065CrossRefPubMedGoogle Scholar
  68. 68.
    Phan, GQ, Yeo, CJ, Cameron, JL,  et al. 1997Pancreaticoduodenectomy for selected periampullary neuroendocrine tumors: fifty patientsSurgery122989997CrossRefPubMedGoogle Scholar
  69. 69.
    Sarmiento, JM, Farnell, MB, Que, FG,  et al. 2002Pancreaticoduodenectomy for islet cell tumors of the head of the pancreas: long-term survival analysisWorld J. Surg.2612671271CrossRefPubMedGoogle Scholar
  70. 70.
    Yeo, CJ, Wang, BH, Anthone, GJ,  et al. 1993Surgical experience with pancreatic islet all tumorsArch. Surg.12811431148PubMedGoogle Scholar
  71. 71.
    Solorzano, CC, Lee, JE, Pisters, PWT,  et al. 2001Nonfunctioning islet all carcinoma of the pancreas: survival results in a contemporary series of 163 patientsSurgery13010781085CrossRefPubMedGoogle Scholar
  72. 72.
    Balzano, G, Zervi, A, Veronesi, P,  et al. 2003Surgical treatment of benign and borderline neoplasms of the pancreatic bodyDig. Surg.20506510CrossRefPubMedGoogle Scholar
  73. 73.
    Christein, JD, Kim, AW, Golshan, MA,  et al. 2003Central pancreatectomy for the resection of benign or low malignant potential neoplasmsWorld J. Surg.27595598CrossRefPubMedGoogle Scholar
  74. 74.
    Fagniez, PL, Kracht, M, Rotman, N 1988Limited conservative pancreatectomy for benign tumors of the pancreasBr. J. Surg.75719PubMedGoogle Scholar
  75. 75.
    Iacono, C, Bortolasi, L, Serio, G 1998Is there a place for central pancreatectomy in pancreatic surgery?J. Gastrointest. Surg.2509517CrossRefPubMedGoogle Scholar
  76. 76.
    Ikeda, S, Matsumoto, S, Maeshiro, K,  et al. 1995Segmental pancreatectomy for the diagnosis and treatment of small lesions in the neck or body of the pancreasHepatogastroenterology42730733Google Scholar
  77. 77.
    Rotman, N, Sastre, B, Faguiez, PL 1993Medial pancreatectomy for tumors of the neck of the pancreasSurgery113532535PubMedGoogle Scholar
  78. 78.
    Sperti, C, Pasquali, C, Ferrronato, A,  et al. 2000Median pancreatectomy for tumors of the neck and body of the pancreasJ. Am. Coll. Surg.190711716CrossRefPubMedGoogle Scholar
  79. 79.
    Yamaguchi, K, Yokohata, K, Onkido, M,  et al. 2000Which is less invasive—distal pancreatectomy or segmental resection?Int. Surg.86297302Google Scholar
  80. 80.
    Partensky, C, Apa, D, Marchal, F,  et al. 1998Medial pancreatectomy with pancreatogastric anastomosis in pancreatic neoplasmsChirurgie123363367PubMedGoogle Scholar
  81. 81.
    Warshaw, AL, Rattner, DW, Fernandez-del Castillo, C,  et al. 1998Middle segment pancreatectomy: a novel technique for conserving pancreatic tissueArch. Surg.133327331CrossRefPubMedGoogle Scholar
  82. 82.
    Corty, SE, Helm, AK, Amico, JA,  et al. 1998The variable penetrance and spectrum of manifestations of multiple endocrine neoplasia type 1Surgery12411061114CrossRefPubMedGoogle Scholar
  83. 83.
    Calender, A 2000Molecular genetics of neuroendocrine tumorsDigestion62318CrossRefPubMedGoogle Scholar
  84. 84.
    Klöppel, G, Willemer, S, Stamm, B,  et al. 1986Pancreatic lesions and hormonal profile of pancreatic tumors in multiple endocrine neoplasia type 1Cancer5718241832PubMedGoogle Scholar
  85. 85.
    Thompson, GB, Heerden, JA, Grant, CS,  et al. 1988Islet all carcinomas of the pancreas: a twenty-year experienceSurgery10410111017PubMedGoogle Scholar
  86. 86.
    Dean, PG, Heerden, JA, Farley, DR,  et al. 2000Are patients with multiple endocrine neoplasia type 1 prone to premature death?World J. Surg.2414371441CrossRefPubMedGoogle Scholar
  87. 87.
    Doherty, GM, Olson, JA, Frisella, MM,  et al. 1998Lethality of multiple endocrine neoplasia type 1World J. Surg.22581587CrossRefPubMedGoogle Scholar
  88. 88.
    Thompson, NW 1998Invited commentaryWorld J. Surg.22677678Google Scholar
  89. 89.
    Demeure, MJ, Klonoff, DC, Karam, JH,  et al. 1991Insulinomas associated with multiple endocrine neoplasia type 1: the need for a different surgical approachSurgery1109981004PubMedGoogle Scholar
  90. 90.
    Lo, CY, Lam, KY, Fan, ST 1998Surgical strategy for insulinomas in multiple endocrine neoplasia type 1Am. J. Surg.175305307CrossRefPubMedGoogle Scholar
  91. 91.
    O’Riordain, DS, O’Brien, T, Heerden, JA,  et al. 1994Surgical management of insulinomas associated with multiple endocrine neoplasia type 1World J. Surg.18488493CrossRefPubMedGoogle Scholar
  92. 92.
    Hellmann, P, Andersson, M, Rastad, J,  et al. 2000Surgical strategy for large or malignant endocrine pancreatic tumorsWorld J. Surg.2413531360CrossRefPubMedGoogle Scholar
  93. 93.
    Norton, JA, Warren, RS, Kelly, MG,  et al. 2003Aggressive surgery for metastatic liver neuroendocrine tumorsSurgery13410571065CrossRefPubMedGoogle Scholar
  94. 94.
    Evans, DB, Skibber, JM, Lee, JE,  et al. 1993Nonfunctioning islet cell carcinoma of the pancreasSurgery11411751182PubMedGoogle Scholar
  95. 95.
    Norton, JA, Kivlen, M, Li, M,  et al. 2003Morbidity and mortality of aggressive resection in patients with advanced neuroendocrine tumorsArch. Surg.138859866CrossRefPubMedGoogle Scholar
  96. 96.
    Schwartz RW, Munfakh NA, Zweng TN, et al. Nonfunctioning cystic neuroendocrine neoplasms of the pancreas. Surgery 1994;115:645-649Google Scholar
  97. 97.
    Strasberg SM, Drebing JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery 2003;133:521–527Google Scholar
  98. 98.
    Capella C, Heitz PU, Höfler H, et al. Revised classification of neuroendocrine tumours of the lung, pancreas and gut. Virchows Arch. 1997;425:547–560Google Scholar

Copyright information

© Société Internationale de Chirurgie 2004

Authors and Affiliations

  • Henning Dralle
    • 1
  • Sabine L. Krohn
    • 1
  • Wolfram Karges
    • 2
  • Bernhard O. Boehm
    • 2
  • Michael Brauckhoff
    • 1
  • Oliver Gimm
    • 1
  1. 1.Department of General, Visceral, and Vascular Surgery, Medical FacultyUniversity of Halle-WittenbergHalleGermany
  2. 2.Department of International Medicine, Section of Endocrinology, Medical FacultyUniversity of UlmUlmGermany

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