Pancreatic neuroendocrine tumors: non-functional
What is the treatment of non-functioning neuroendocrine tumors of the pancreas including their prognosis?
Surgical resection is the mainstay of treatment for patients with non-functioning pancreatic neuroendocrine tumors. The goal of the operation is cure of the disease as opposed to stopping symptoms due to hormones. Operations for non-functioning pancreatic neuroendocrine tumors may include distal pancreatectomy, or pancreaticoduodenectomy (Whipple procedure). These is controversy regarding the treatment of metastatic disease. Unlike functional tumors where surgical debulking is generally recommended to relieve symptoms from hormone secretion, since non-functional pancreatic neuroendocrine tumors do not produce symptom-causing hormones, the goal of surgery is to prolong survival. There is general agreement that in the setting of isolated metastases, surgery may be prudent. In the setting of widespread metastases, surgery is unlikely to provide benefit. There is also debate about the biologic behavior of non-functional neuroendocrine tumors of the pancreas. As mentioned above, many report that non-functioning neuroendocrine tumors are larger at presentation than functioning neuroendocrine tumors tumors. Even more controversy persists as to whether patients with non-functioning pancreatic neuroendocrine tumors have a worse prognosis than patients with functioning pancreatic neuroendocrine tumors. Several series have reported diminished 5-year survival in patients with non-functional tumors. However, other reports find no significant difference in survival or even incidence of metastatic disease on presentation. This discrepancy may be related to multiple factors such as the relatively small patient numbers in each of the studies and variable numbers of patients with more benign tumors such as insulinomas present in some reports. Even in the studies demonstrating a difference in five-year survival, these differences were not dramatic (77% in the functional group vs 52% in the non-functional group). Thus, the prognosis of non-functioning pancreatic Neuroendocrine may be slightly worse than those with functional ones.