Aktuelle Standards in der Diagnostik und chirurgischen Therapie pankreatischer neuroendokriner Tumoren

Pankreatische neuroendokrine Tumoren (Pan-NET) sind seltene, heterogene Tumoren mit komplexer Diagnostik und Therapie. Das variable Verhalten dieser Tumoren schließt eine einheitliche chirurgische Strategie aus. Dieser Beitrag beleuchtet aktuelle Standards in der Diagnostik und chirurgischen Behandlung, diskutiert innovative Ansätze wie ultraschallgestützte Verfahren und gibt Einblicke in die Bedeutung systemischer Therapien.

Kernaussagen

• Etwa 17% der Pan-NET sind mit einem vererbten Syndrom assoziiert, wie zum Beispiel MEN1 oder MEN4, VHL und TSC.

• NF-Pan-NET machen etwa 70% der Gesamtzahl der Pan-NET aus.

• Bei Patienten mit präoperativ lokalisiertem Insulinom sollte, wenn technisch möglich, eine parenchymsparende Resektion und ein minimalinvasives Vorgehen erwogen werden.

• Bei sporadischen Pankreasgastrinomen wird eine Lymphadenektomie empfohlen.

• Das häufigste Verfahren bei MEN1-assoziiertem ZES ist die Duodenotomie mit Exzision von Duodenalwandtumoren und systematischer Lymphadenektomie.

• Da eine PPPD mit einer 60–80%igen Chance auf biochemische Heilung bei Patienten mit MEN1-bedingtem ZES einhergeht, sollte die Indikation zur PPPD mit dem Patienten im Hinblick auf Nutzen und Risiken besprochen werden.

• Symptomatische NF-Pan-NET > 2 cm sollten chirurgisch reseziert werden.

• Kleine (< 2 cm), asymptomatische NF-Pan-NET können beobachtet werden.

• Die Metastasenresektion bei Patienten mit hepatisch metastasierten Pan-NET kann das Gesamtüberleben verbessern und es gibt Hinweise, dass die Primariusresektion bei nicht resektablen Lebermetastasen ebenfalls einen Überlebensvorteil bringen kann.

• Für Patienten, die nicht für eine Lebermetastasenresektion infrage kommen, bleiben lebergerichtete Therapien und systemische Behandlungen praktikable Optionen mit nachgewiesenem Überlebensvorteil bei metastasierter Erkrankung.

Schlüsselwörter

Pan-NEN - Pan-NET - neuroendokriner Tumor - Pankreas - chirurgische Therapie

Publication History

Article published online:
24 February 2025

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