Skip to main content
SpringerLink
Log in

Chirurgie endokriner Tumoren des Pankreas

Surgical therapy of pancreatic endocrine tumors

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Aufgrund des zunehmenden klinischen Einsatzes moderner Schnittbildgebung werden bisher seltene neuroendokrine Tumoren (NET) des Pankreas immer häufiger zufällig entdeckt. Klinisch werden funktionell inaktive von hormonell aktiven NET unterschieden. Sie werden als funktionell aktiv klassifiziert und nach dem durch sie produzierten Hormon benannt, wenn die Hormonproduktion spezifische Symptome verursacht.

Ziel

Der Schwerpunkt dieser Übersichtsarbeit ist die Darstellung der chirurgischen Therapiestandards bei NET des Pankreas.

Material und Methoden

Aufgrund des Fehlens großer randomisierter Studien ist die Evidenz der Therapieleitlinien niedrig und basiert vornehmlich auf retrospektiven Studien.

Ergebnisse

Von chirurgischer Seite bieten sich für diese Entität minimal-invasive Operationstechniken an. Allerdings ist auch im fortgeschrittenen Krankheitsstadium durch eine aggressive chirurgische Therapie noch eine deutliche Verlängerung des Überlebens möglich.

Schlussfolgerung

Der Krankheitsverlauf ist sehr variabel. Während kleine, benigne NET normalerweise durch Resektion geheilt werden können, ist die Prognose bei den übrigen NET schlechter.

Abstract

Context

Due to the increasing use of cross-sectional imaging in the clinical setting, formerly rare pancreatic neuroendocrine tumors (NETs) are observed more and more frequently. Based on the symptomatology NETs are classified as functional or as nonfunctional tumors. The hallmarks of functional NETs are the syndromes they cause through the secretion of specific hormones while nonfunctional tumors do not cause specific clinical syndromes.

Objective

This review focuses on the current standards of surgical therapy of NETs of the pancreas.

Material and methods

Due to the lack of randomized controlled trials the evidence level is low in many instances and treatment guidelines are mostly based on smaller retrospective studies.

Results

The natural course of NETs is highly variable.

Conclusion

Small, benign neoplasms are usually curable by surgical resection and ideally suited for laparoscopic therapy. The prognosis in other NETs is poor but aggressive surgical therapy can prolong survival even in advanced stages of disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Alexander HR, Fraker DL, Norton JA et al (1998) Prospective study of somatostatin receptor scintigraphy and its effect on operative outcome in patients with Zollinger-Ellison syndrome. Ann Surg 228:228–238

    Article  PubMed  CAS  Google Scholar 

  2. Bartsch DK, Fendrich V, Langer P et al (2005) Outcome of duodenopancreatic resections in patients with multiple endocrine neoplasia type 1. Ann Surg 242:757–764 (discussion 764–756)

    Article  PubMed  Google Scholar 

  3. Doppman JL, Jensen RT (1999) Localization of gastroenteropancreatic tumours by angiography. Ital J Gastroenterol Hepatol 31(Suppl 2):S163–S166

    PubMed  Google Scholar 

  4. Dudczak R, Traub-Weidinger T (2010) PET and PET/CT in endocrine tumours. Eur J Radiol 73:481–493

    Article  PubMed  Google Scholar 

  5. Falconi M, Bartsch DK, Eriksson B et al (2012) ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms of the digestive system: well-differentiated pancreatic non-functioning tumors. Neuroendocrinology 95:120–134

    Article  PubMed  CAS  Google Scholar 

  6. Fendrich V, Bartsch DK (2011) Surgical treatment of gastrointestinal neuroendocrine tumors. Langenbecks Arch Surg 396:299–311

    Article  PubMed  Google Scholar 

  7. Fendrich V, Langer P, Celik I et al (2006) An aggressive surgical approach leads to long-term survival in patients with pancreatic endocrine tumors. Ann Surg 244:845–851 (discussion 852–843)

    Article  PubMed  Google Scholar 

  8. Jensen RT, Berna MJ, Bingham DB et al (2008) Inherited pancreatic endocrine tumor syndromes: advances in molecular pathogenesis, diagnosis, management, and controversies. Cancer 113:1807–1843

    Article  PubMed  Google Scholar 

  9. Jensen RT, Cadiot G, Brandi ML et al (2012) ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms: functional pancreatic endocrine tumor syndromes. Neuroendocrinology 95:98–119

    Article  PubMed  CAS  Google Scholar 

  10. Jensen RT, Niederle B, Mitry E et al (2006) Gastrinoma (duodenal and pancreatic). Neuroendocrinology 84:173–182

    Article  PubMed  CAS  Google Scholar 

  11. Kimura W, Kuroda A, Morioka Y (1991) Clinical pathology of endocrine tumors of the pancreas. Analysis of autopsy cases. Dig Dis Sci 36:933–942

    Article  PubMed  CAS  Google Scholar 

  12. Klimstra DS, Modlin IR, Coppola D et al (2010) The pathologic classification of neuroendocrine tumors: a review of nomenclature, grading, and staging systems. Pancreas 39:707–712

    Article  PubMed  Google Scholar 

  13. Kloppel G, Couvelard A, Perren A et al (2009) ENETS consensus guidelines for the standards of care in neuroendocrine tumors: towards a standardized approach to the diagnosis of gastroenteropancreatic neuroendocrine tumors and their prognostic stratification. Neuroendocrinology 90:162–166

    Article  PubMed  Google Scholar 

  14. Kloppel G, Heitz PU (1988) Pancreatic endocrine tumors. Pathol Res Pract 183:155–168

    Article  PubMed  CAS  Google Scholar 

  15. Mazzaferro V, Pulvirenti A, Coppa J (2007) Neuroendocrine tumors metastatic to the liver: how to select patients for liver transplantation? J Hepatol 47:460–466

    Article  PubMed  Google Scholar 

  16. Metz DC, Jensen RT (2008) Gastrointestinal neuroendocrine tumors: pancreatic endocrine tumors. Gastroenterology 135:1469–1492

    Article  PubMed  CAS  Google Scholar 

  17. Nilsson O, Van Cutsem E, Delle Fave G et al (2006) Poorly differentiated carcinomas of the foregut (gastric, duodenal and pancreatic). Neuroendocrinology 84:212–215

    Article  PubMed  CAS  Google Scholar 

  18. Norton JA, Fraker DL, Alexander HR et al (2006) Surgery increases survival in patients with gastrinoma. Ann Surg 244:410–419

    PubMed  Google Scholar 

  19. Norton JA, Kivlen M, Li M et al (2003) Morbidity and mortality of aggressive resection in patients with advanced neuroendocrine tumors. Arch Surg 138:859–866

    Article  PubMed  Google Scholar 

  20. O’toole D, Salazar R, Falconi M et al (2006) Rare functioning pancreatic endocrine tumors. Neuroendocrinology 84:189–195

    Article  Google Scholar 

  21. Oberg K, Akerstrom G, Rindi G et al (2010) Neuroendocrine gastroenteropancreatic tumours: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl 5):v223–v227

    Article  PubMed  Google Scholar 

  22. Patel KK, Kim MK (2008) Neuroendocrine tumors of the pancreas: endoscopic diagnosis. Curr Opin Gastroenterol 24:638–642

    Article  PubMed  Google Scholar 

  23. Pavel M, Baudin E, Couvelard A et al (2012) ENETS consensus guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut, midgut, hindgut, and unknown primary. Neuroendocrinology 95:157–176

    Article  PubMed  CAS  Google Scholar 

  24. Sarmiento JM, Heywood G, Rubin J et al (2003) Surgical treatment of neuroendocrine metastases to the liver: a plea for resection to increase survival. J Am Coll Surg 197:29–37

    Article  PubMed  Google Scholar 

  25. Sarmiento JM, Que FG (2003) Hepatic surgery for metastases from neuroendocrine tumors. Surg Oncol Clin N Am 12:231–242

    Article  PubMed  Google Scholar 

  26. Solorzano CC, Lee JE, Pisters PW et al (2001) Nonfunctioning islet cell carcinoma of the pancreas: survival results in a contemporary series of 163 patients. Surgery 130:1078–1085

    Article  PubMed  CAS  Google Scholar 

  27. Stabile BE, Morrow DJ, Passaro E Jr (1984) The gastrinoma triangle: operative implications. Am J Surg 147:25–31

    Article  PubMed  CAS  Google Scholar 

  28. Vagefi PA, Razo O, Deshpande V et al (2007) Evolving patterns in the detection and outcomes of pancreatic neuroendocrine neoplasms: the Massachusetts General Hospital experience from 1977–2005. Arch Surg 142:347–354

    Article  PubMed  Google Scholar 

  29. Yao JC, Hassan M, Phan A et al (2008) One hundred years after „carcinoid“: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 26:3063–3072

    Article  PubMed  Google Scholar 

  30. Zhao YP, Zhan HX, Zhang TP et al (2011) Surgical management of patients with insulinomas: result of 292 cases in a single institution. J Surg Oncol 103:169–174

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    D. Bausch &  T. Keck MBA

Authors
  1. D. Bausch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Keck MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Keck MBA.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bausch, D., Keck, T. Chirurgie endokriner Tumoren des Pankreas. Onkologe 19, 224–229 (2013). https://doi.org/10.1007/s00761-012-2394-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00761-012-2394-8

Schlüsselwörter

Keywords

Search

Navigation