Neoplasms of the Endocrine Pancreas Guidelines

Updated: Feb 01, 2018
  • Author: Evan S Ong, MD, MS; Chief Editor: Neetu Radhakrishnan, MD  more...
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Guidelines

Guidelines Summary

Practice guidelines from the National Comprehensive Cancer Network (NCCN) recommend resection as the primary treatment for locoregional disease. Patients with other life-limiting co-morbidities or high surgical risk should be excluded, particulalry when tumors are small and indolent. Additional recommendation include the following [56] :

  • Observation alone is an option for selected cases of incidental nonfunctional local tumors ≤1cm
  • Resection of of large >2cm node-positive nonfunctional tumors should removal of the tumor with negative margins (including adjacent organs) and regional lymph nodes.
  • Resection of lymph nodes should be considered for nonfunctional tumors between 1 and 2cm
  • Observation or exploratory surgery for patients with occult gastrinoma
  • Gastrinoma in the duodenum require duodenotomy and intraoperative ultrasound with local resection or enucleation and periduodenial node dissection
  • Distal pancreatectomy is indicated for gastrinomas in the distal pancreas 
  • The primary treatment for insulinomas is enucleation
  • Distal pancreatectomy with splenectomy and peripancreatic lymph node resection is the treatment for glucagonomas