Therapy for locoregional disease: pancreas

Surgery is the mainstay for the treatment of localized pancreatic neuroendocrine neoplasms tumors (PanNENs). Either formal or limited pancreatic resections are commonly used for large ( > 2 cm), sporadic PanNENs and for functioning neoplasms. However, given the high rate of perioperative morbidity and mortality after pancreatic surgery and the indolent behavior of PanNETs, a conservative approach consisting in active surveillance has been proposed for small, nonfunctioning, low-to-intermediate grade tumors. Treatment of locally advanced PanNENs appears particularly challenging. Although surgery can be proposed in the presence of tumor invasion of nearby organs, it is currently unclear whether an aggressive surgical approach is associated with improved survival outcomes. On the other hand, it has been suggested that chemotherapy or peptide receptor radionuclide therapy (PRRT) are effective in the neoadjuvant setting and may lead to increased rates of curative resections in patients with locally advanced disease. Studies investigating the molecular underpinnings of PanNENs in relation to their clinical behavior are needed for optimal treatment tailoring.