J Dig Cancer Rep.  2021 Jun;9(1):19-24. 10.52927/jdcr.2021.9.1.19.

Management of Small Pancreatic Neuroendocrine Neoplasm

  • 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
  • 2Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
  • 3Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea


The incidence of small and asymptomatic pancreatic neuroendocrine neoplasms (PNENs) has been increased due to the widespread use of high-resolution imaging techniques and endoscopic procedures in screening programmes. Most of PNENs are indolent neoplasms with slow-growing. However, sometimes, PNENs show local invasion or metastasis with poor prognosis. The management of small, nonfunctioning PNENs remain under debate. The National Comprehensive Cancer Network guidelines recommend observation in selected cases of small PNENs less than 2 cm. Pancreatic surgeons are divided into two factions: “the hawks,” who indicate the high risk of malignancy even in small PNENs and, therefore, the need for an aggressive surgical treatment, and the “the doves,” who accepts the risk of malignancy in some ≤ 2 cm PNENs, advocate that the risk of overtreating many benign ≤ 2 cm PNENs would be much higher. As the pancreatic surgery remains a high-risk operation with a 28–30% morbidity and 1% mortality, the decision for small PNENs is challenging.


Pancreatic neuroendocrine neoplasm; Small; Asymptomatic; Non-functional
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