胰腺神经内分泌肿瘤(PNETs)的治疗:手术策略与争议。

IF 3.7 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Endocrine Practice Pub Date : 2024-10-01 DOI:10.1016/j.eprac.2024.07.010
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引用次数: 0

摘要

目的:胰腺神经内分泌肿瘤(PNET胰腺神经内分泌肿瘤(PNET)是一种不常见的肿瘤,其发病率正在不断上升。这些肿瘤的治疗方法也在不断发展。本综述探讨了外科手术目前在这些肿瘤治疗中的作用。 方法:使用多个数据库(包括 PubMed、MEDLINE 和 Science Direct)对过去 10 年间发表的研究进行了鉴定。搜索关键词包括胰腺神经内分泌肿瘤、治疗和手术。此外,还查阅了几个主要团体的临床实践指南和更新内容:手术在治疗散发性功能性和菲利贝尔非功能性胰腺内分泌肿瘤中仍然发挥着重要作用。越来越多的人接受保胰方法,以替代对特定患者的正式胰腺切除术。对于大小小于2厘米的NF-PNET,观察和等待或内镜消融等方法可能是手术的合理替代方案。MEN-1 患者的手术决策仍然很复杂,在胃泌素瘤等某些情况下,手术决策还存在很大争议。由于出现了更有效的全身和肝脏导向疗法,手术在晚期患者中的作用已大大降低。然而,晚期疾病的最佳治疗方法和顺序仍未明确,有人认为手术在这些患者中未得到充分利用:结论:手术仍是治疗 PNET 的主要方式。结论:手术仍是治疗 PNETs 的主要方式。鉴于现有治疗方法繁多、争议不断、情况不断变化,治疗变得越来越复杂。一个包括外科在内的经验丰富的多学科团队对这些患者的治疗至关重要。
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Management of Pancreatic Neuroendocrine Tumors: Surgical Strategies and Controversies

Objective

Pancreatic neuroendocrine tumors (PNETs) are uncommon tumors which are increasing in incidence. The management of these tumors continues to evolve. This review examines the current role of surgery in the treatment of these tumors.

Methods

Studies published over the past 10 years were identified using several databases including PubMed, MEDLINE, and Science Direct. Search terms included PNETs, treatment, and surgery. Clinical practice guidelines and updates from several major groups were reviewed.

Results

Surgery continues to have a major role in the treatment of sporadic functional and nonfunctional PNETs. Pancreas-sparing approaches are increasingly accepted as alternatives to formal pancreatic resection in selected patients. Options such as watch and wait or endoscopic ablation may be reasonable alternatives to surgery for non-functional PNETs < 2 cm in size. Surgical decision-making in multiple endocrine neoplasia type 1 patients remains complex and in some situations such as gastrinoma quite controversial. The role of surgery has significantly diminished in patients with advanced disease due to the advent of more effective systemic and liver-directed therapies. However, the optimal treatments and sequencing in advanced disease remain poorly defined, and it has been suggested that surgery is underutilized in these patients.

Conclusions

Surgery remains a major treatment modality for PNETs. Given the plethora of available treatments, ongoing controversies and the changing landscape, management has become increasingly complex. An experienced multidisciplinary team which includes surgery is essential to manage these patients.
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来源期刊
Endocrine Practice
Endocrine Practice ENDOCRINOLOGY & METABOLISM-
CiteScore
7.60
自引率
2.40%
发文量
546
审稿时长
41 days
期刊介绍: Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.
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