Pancreatic Surgery for Endocrine Tumors

Norman W. Thompson, MD

A variety of surgical procedures are useful in the treatment of endocrine tumors of the pancreas. The selection of a specific surgical technique or procedure in the management of an endocrine tumor of the pancreas depends on a number of important factors that must be considered in each case: the functional nature of the tumor, its benignity or malignancy, and whether it is a component of multiple endocrine neoplasia (MEN) type 1 or is sporadic in its occurrence. Furthermore, when a tumor is malignant, one must determine whether it invades essential contiguous structures such as the superior mesenteric vessels or whether metastases are present but are limited to lymph nodes. Usually hepatic metastasis implies incurability, although a solitary liver metastasis from an islet cell tumor should be treated aggressively, provided that the primary tumor can be completely removed. For the purposes of this discussion, endocrine tumors are classified into those that are sporadic and those that are associated with MEN 1. They are then further subdivided into those that are functional and those with no apparent hormonal activity.

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