Surgical treatment of endocrine tumors of the pancreas

Surgeons have a key role in the management of most endocrine tumors of the pancreas. The objective of surgery is either curative or palliative, according to the resectability of the tumor. The preoperative management includes the assertion of the tumoral syndrome, the localization of the tumor by imaging techniques and the preparation of the patient to surgery. Emergency indications to operate have become exceptional since the temporary control of inappropriate secretions by pharmacologic agents is available. Intraoperative ultrasonography is useful both for detection of the tumors and selection of the best procedure for resection. A careful postoperative follow-up is advocated for patients with malignant tumors and MEN-1, since iterative resections can be undertaken in case of limited tumoral recurrence or liver metastases. The place of hepatic transplantation for diffuse metastases is still under evaluation.