Neoplasms of the Endocrine Pancreas Guidelines

Updated: Jun 14, 2021
  • 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, particularly when tumors are small and indolent. Additional recommendation include the following [57] :

  • Incidental nonfunctional local tumors ≤1 cm - In selected cases, observation alone is an option.
  • Nonfunctional tumors 1-2 cm in size - Resection of lymph nodes should be considered.
  • Large (> 2 cm) node-positive nonfunctional tumors - Resection should involve removal of the tumor with negative margins (including adjacent organs) and regional lymph nodes.
  • Occult gastrinoma - Observation or exploratory surgery are options.
  • Gastrinomas in the duodenum require duodenotomy and intraoperative ultrasound with local resection or enucleation and periduodenial node dissection.
  • Gastrinomas in the distal pancreas - Distal pancreatectomy is indicated.
  • Insulinomas - The primary treatment is enucleation.
  • Glucagonomas - Treatment is distal pancreatectomy with splenectomy and peripancreatic lymph node resection.