title: Surgery management for sporadic small (≤2 cm), non-functioning pancreatic neuroendocrine tumors: a consensus statement by the Chinese Study Group for Neuroendocrine Tumors (CSNET).
abstract: The incidence of small (≤2 cm), non-functioning pancreatic neuroendocrine tumors (NF-pNETs) increased in the last decades. Before making appropriate strategy for patients with NF-pNETs ≤2 cm, pathological confirmation is vital. Incidentally diagnosed, sporadic small NF-pNETs may bring aggressive behavior and poor prognosis, such as extrapancreatic extension, lymph nodal metastasis, distant metastasis and recurrence, even causing disease-related death. Understanding and formulating an appropriate strategy for the patients with sporadic small, non-functioning pancreatic neuroendocrine tumors have been controversial for some time. Although several studies have reported that patients with NF-pNETs ≤2 cm had less rate of malignant behavior compared with larger ones (>2 cm); and the surgery approach may leading to surgery-related pancreatic complications; but there is still a lack of level I evidence to convince surgeons to abandon all cases with sporadic small NF-pNETs. Based on an updated literature search and review, the members of the Chinese Study Group for Neuroendocrine Tumors (CSNET) from high-volume centers have reached a consensus on the issue of the management strategy for the sporadic small NF-pNETs. We recommend that, except for some selected patients with NF-pNETs <1 cm, incidentally discovered and unacceptable surgical risks, all others with NF-pNETs ≤2 cm should undergo tumor resection with lymph node dissection or at least lymph node sampling and careful postoperative surveillance.
authors.affiliation: Department of General Surgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, P.R. China.
authors.forename: Guang
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authors.affiliation: Department of General Surgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, P.R. China.
authors.forename: Meng
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authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China.
authors.forename: Jie
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authors.lastname: Chen
authors.affiliation: Department of Hepatopancreatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China.
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authors.affiliation: Department of Gastroenterology, Nanfang Hospial, Southern Medical University, Guangzhou, Guangdong, P.R. China.
authors.forename: Ye
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authors.lastname: Chen
authors.affiliation: Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
authors.forename: Deliang
authors.initials: D
authors.lastname: Fu
authors.affiliation: Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China.
authors.forename: Baohua
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authors.lastname: Hou
authors.affiliation: Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China.
authors.forename: Heguang
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authors.lastname: Huang
authors.affiliation: Department of Radiology, Cancer Hospital/Institute, Chinese Academy of Medical Sciences, Beijing, P.R. China.
authors.forename: Liming
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authors.lastname: Jiang
authors.affiliation: Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University; Pancreatic Cancer Institute, Fudan University, Shanghai, P.R. China.
authors.forename: Kaizhou
authors.initials: K
authors.lastname: Jin
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.
authors.forename: Nengwen
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authors.affiliation: Department of Radiology, Peking University Cancer Hospital and Institute, Beijing, P.R. China.
authors.forename: Ying
authors.initials: Y
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authors.affiliation: Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China.
authors.forename: Yong
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authors.affiliation: Department of Oncology, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China.
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authors.affiliation: Department of General Surgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, P.R. China.
authors.forename: An'an
authors.initials: A
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authors.affiliation: Department of Pathology, China-Japan Friendship Hospital, Beijing, P.R. China.
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authors.affiliation: Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University; Pancreatic Cancer Institute, Fudan University, Shanghai, P.R. China.
authors.forename: Quanxing
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authors.affiliation: Department of Radiology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, P.R. China.
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authors.affiliation: Department of General Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
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authors.affiliation: Department of Pathology, Shanghai Cancer Center, Fudan University, Shanghai, P.R. China.
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authors.affiliation: Department of Pancreatic Surgery, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, P.R. China.
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authors.affiliation: Department of Hepatopancreatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China.
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authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.
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authors.affiliation: Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing, P.R. China.
authors.forename: Huangying
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authors.affiliation: Department of Gastroenterology, Jiangsu People's Hospital, Nanjing Medical University, Nanjing, Jiangsu, P.R. China.
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authors.affiliation: Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Research Center for Liver Diseases, Kunming, Yunnan, P.R. China.
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authors.affiliation: Department of General Surgery, Peking University First Hospital, Beijing, P.R. China.
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authors.forename: Zhaohui
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authors.affiliation: Department of General Surgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, P.R. China.
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mesh_terms: D032921:Consensus; D019468:Disease Management; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome