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Chirurgie bei neuroendokrinen Neoplasien des Pankreas: State of the Art

Surgery of pancreatic neuroendocrine neoplasms: state of the art

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Zusammenfassung

Pankreatische neuroendokrine Neoplasien (pNEN) werden mit zunehmender Inzidenz verzeichnet und vermehrt in frühen (resektablen) Stadien diagnostiziert. Aufgrund der Seltenheit dieser Neoplasien beruhen die Empfehlungen der verfügbaren Leitlinien vor allem auf retrospektiven Daten. Die onkologische und chirurgische Therapie dieser seltenen Erkrankung sollte spezialisierten Zentren vorbehalten sein. Bei resektablem Befund ohne Hinweis auf diffuse Filialisierung ist die kurativ intendierte vollständige Entfernung anzustreben. Alternativ zur chirurgischen Resektion wurde bei kleinen nichtfunktionellen Tumoren < 2 cm die Watch-and-wait-Strategie empfohlen, neuere Daten zeigen jedoch ein längeres Überleben nach Resektion von Neoplasien in der Größe zwischen 1 und 2 cm. Für benigne Insulinome und nichtfunktionelle gut differenzierte kleine pNEN stehen parenchymsparende Verfahren wie die Enukleation oder die Segmentresektion zur Verfügung. Die Frage des Einflusses von Lymphknotenmetastasen auf das langfristige tumorfreie und Gesamtüberleben und damit der Stellenwert der systematischen Lymphadenektomie ist nicht abschließend geklärt. Bei Neoplasien > 2 cm ist eine formelle Resektion mit Lymphadenektomie anzustreben. Minimal-invasive und robotisch assistierte Verfahren haben einen zunehmenden Stellenwert auch bei formellen Resektionen.

Abstract

Pancreatic neuroendocrine neoplasms (pNEN) have a rising incidence and are increasingly diagnosed at early and thus potentially resectable stages. Due to the rarity of these neoplasms the recommendations of currently available guidelines are mainly based on retrospective data. Surgical and oncological treatment of these rare diseases should only be performed at specialized centers. In cases of resectability without indications of diffuse metastases, complete resection with curative intent should be the treatment of choice. For small nonfunctional pNENs < 2 cm watch and wait strategies are recommended as an alternative to surgical treatment. Recent data, however, also showed an increased survival even of small (1–2 cm) pNENs after resection. For benign insulinomas and small nonfunctional well-differentiated pNENs parenchyma-sparing procedures, such as enucleation and segmental resection are available. The question of the influence of lymph node metastases on long-term disease-free survival and overall survival and consequently the role of systematic lymphadenectomy is still a matter of debate. In pNENs > 2 cm formal resection with lymphadenectomy is considered the gold standard. Minimally invasive and robotic-assisted procedures are of increasing importance also for formal pancreatic resection.

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  1. Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinik Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland

    A. Nießen, S. Schimmack, F. Billmann & T. Hackert

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  1. A. Nießen
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  3. F. Billmann
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Correspondence to T. Hackert.

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A. Nießen, S. Schimmack, F. Billmann und T. Hackert geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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T. Hackert, Heidelberg

M.W. Büchler, Heidelberg

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Nießen, A., Schimmack, S., Billmann, F. et al. Chirurgie bei neuroendokrinen Neoplasien des Pankreas: State of the Art. Chirurgie 93, 745–750 (2022). https://doi.org/10.1007/s00104-022-01641-8

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