Laparoscopic resection of pancreatic neuroendocrine tumors

Abstract

Pancreatic neuroendocrine tumors (PNETs) are a rare heterogeneous group of endocrine neoplasms. Surgery remains the best curative option for this type of tumor. Over the past two decades, with the development of laparoscopic pancreatic surgery, an increasingly larger number of PNET resections are being performed by these minimally-invasive techniques. In this review article, the various laparoscopic surgical options for the excision of PNETs are discussed. In addition, a summary of the literature describing the outcome of these treatment modalities is presented.

Keywords: Laparoscopic resection of gastrointestinal; Laparoscopy; Pancreatic neuroendocrine tumor; Surgery.

Figure 1

Tumors of the pancreatic head. A: A pancreatic neuroendocrine tumor (PNET) involving the posterior aspect of the pancreatic head, after adequate exposure by extensive kocherization and medial retraction of the pancreatic head, prior to enucleation; B: A PNET involving the inferior border of the body/tail of the pancreas. Resection is being performed using the LigaSure device; C: PNETs located in the posterior aspect of the body/tail occasionally require partial resection of the splenic vein in order to perform successful enucleation; D: The intraoperative appearance after performance of spleen-preserving distal pancreatectomy with splenic vessel preservation; E: The intraoperative appearance after performance of spleen-preserving distal pancreatectomy without splenic vessel preservation. Figure 1D and E represent patients with multiple endocrine neoplasia-1, with an additional PNET located in the head. This synchronous tumor will be excised by enucleation.

Figure 2

An image from intraoperative ultrasound demonstrating an insulinoma involving the pancreatic tail.