Initial treatment strategy of pancreatic neuroendocrine neoplasms

About 20% -30% of pancreatic neuroendocrine neoplasms (pNENs) are resectable after the initial diagnosis, and about 70% -80% of pNENs are locally advanced or metastatic tumors. For resectable pNENs, primary and metastatic lesions are suggested to be resected, and for locally advanced or metastatic functional tumors, debulking surgery is encouraged for controlling the symptoms and alleviating the life quality; debulking surgery could not improve the overall survival of patients with non functional neuroendocrine tumors, unless there are life threatening complications such as bleeding or obstruction. For type Ⅰ liver metastasis, simultaneous resection of primary and metastatic lesions is advised; while for type Ⅱ liver metastasis, systemic treatment combined with local treatment (radio frequency ablation, transcatheter arterial chemoembolization and transartery embolization) is effective; for type Ⅲ liver metastasis, target therapy such as Sunitinib, Everolimus combined with long acting Sandostatin is effective. No adjuvant therapy is needed after radical resection of pNENs, while following therapy is suggested for patients after metastatic pNENs resection.