Pankreatik Nöroendokrin Tümörlerde Cerrahi Müdahale Her Zaman Zorunlu Değil

SURGERY IS NOT MANDATORY FOR ALL PANCREATIC NEUROENDOCRINE TUMORS

Non-functional pancreatic neuroendocrine tumors (p- NETs) are rare pancreatic neoplasms with low metastasis risks. While resection with lymphadenectomy is the preferred treatment, selected cases may benefit from close follow-up without surgery. We report outcomes of patients managed non-surgically. Patients were prospectively selected based on tumor size <20 mm, non-functionality, Ki67 index <10%, and well-differentiated histology. Analysis included 8 out of 10 patients followed for >24 months between January 2018 -December 2024.

Median age of the 8 patients (3 male, 5 female) was 58 years (range: 34—75). Seven lesions were incidentally diagnosed, and one patient presented with pain. MRI identified lesions in all cases, with additional CT in 5 and PET (Ga-68 or FDG) in 6. Tumors were evenly distributed between the pancreatic head (n=4) and body (n=4), with a mean size of 13 mm (range: 8—19 mm). Imaging revealed no lymph node or distant metastases.

EUS-guided biopsy confirmed well-differentiated tumors in all patients, with a mean Ki-67 index of 2% (range: 1—8%). Seven patients had grade 1 p-NETs, and one had grade 2. Mean NSE levels were 15 ng/mL (range: 9—23), and chromogranin A was 102 ng/mL (range: 21— 204) in 5 patients, with no significant changes during follow-up.

Patients were monitored for a mean of 42 months (range: 24—84) with annual MRI and NSE assessments, showing no tumor progression.

Non-surgical management of small, well-differentiated p-NETs with low Ki67 index is effective, avoiding un- necessary surgeries.