Related Experiment Video
Updated: Oct 5, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
How to Select Patients Affected by Neuroendocrine Neoplasms for Surgery
Francesca Fermi1, Valentina Andreasi1,2, Francesca Muffatti1
1Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, OSR ENETS Center of Excellence, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
Purpose Of Review:
The aim of this review was to discuss how to select patients with gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) for surgery.
Recent Findings:
Surgical resection represents the mainstay for the curative treatment of GEP-NENs. Conservative strategies, such as endoscopic resection and active surveillance, have been recently advocated for the management of patients with small and asymptomatic GEP-NENs. On the other hand, patients with GEP-NENs showing features of aggressiveness should be managed by surgical resection with lymphadenectomy, when the surgical risk is considered acceptable. An accurate selection is important also in the setting of advanced disease, where surgery can provide a survival benefit in the context of a multimodal treatment strategy. Surgical and oncological risk should be always assessed in order to define indications for surgery in patients with GEP-NENs. Given the variety of available treatment options, surgical indication should be always shared with a dedicated multidisciplinary team.
Insights
Selecting patients with gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) for surgery requires careful risk assessment. Surgery is a primary curative treatment, but conservative options exist for small, asymptomatic GEP-NENs.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Oncology
Background:
- Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are a diverse group of tumors.
- Surgical resection is the primary curative treatment for GEP-NENs.
- Conservative management strategies are emerging for specific GEP-NENs.
Purpose of the Study:
- To review and discuss patient selection criteria for surgical resection of GEP-NENs.
- To highlight the role of surgery in both curative and palliative settings for GEP-NENs.
- To emphasize the importance of multidisciplinary team involvement in surgical decision-making.
Main Methods:
- Review of current literature on surgical management of GEP-NENs.
- Analysis of factors influencing surgical indications, including tumor characteristics and patient risk.
- Discussion of conservative versus surgical approaches based on GEP-NEN presentation.
Main Results:
- Surgical resection is the mainstay for curative treatment of GEP-NENs.
- Endoscopic resection and active surveillance are viable for small, asymptomatic GEP-NENs.
- Aggressive GEP-NENs warrant surgical resection with lymphadenectomy if surgical risk is acceptable.
- Surgery can improve survival in advanced GEP-NENs as part of multimodal therapy.
Conclusions:
- Accurate patient selection is crucial for optimizing surgical outcomes in GEP-NENs.
- Assessment of surgical and oncological risk is essential for defining surgical indications.
- Multidisciplinary team consultation is vital for shared decision-making in GEP-NEN management.
