Journal of Digestive Cancer Reports

Korean Society of Gastrointestinal Cancer Research (대한소화기암연구학회)
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Management of Small Pancreatic Neuroendocrine Neoplasm

크기가 작은 췌장 신경내분비종양의 관리

  • Paik, Woo Hyun (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Lee, Kyong Joo (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Jang, Sung Ill (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Cho, Jae Hee (Department of Internal Medicine, Yonsei University College of Medicine)
  • 백우현 (서울대학교 의과대학 내과학교실) ;
  • 이경주 (연세대학교 원주의과대학 내과학교실) ;
  • 장성일 (연세대학교 의과대학 내과학교실) ;
  • 조재희 (연세대학교 의과대학 내과학교실)
  • Received : 2021.05.11
  • Accepted : 2021.05.16
  • Published : 2021.06.01
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Abstract

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.

고해상도 영상기법과 내시경술기의 발전으로 인해 작고 무증상인 췌장 신경내분비종양의 발생률은 증가하고 있다. 대부분의 췌장 신경내분비종양은 느리게 성장하나 때때로 예후가 좋지 않은 국소 침윤 또는 전이를 보인다. 작고 비기능성인 췌장 신경내분비종양의 관리 방법에 대해서는 아직 정립되지 않았다. 미국종합암네트워크 지침은 2 cm 미만의 작은 췌장 신경내분비종양에서는 관찰을 권장한다. 외과 의사의 의견은 두 부류로 나뉘어진다. 작은 췌장 신경내분비종양에서도 악성의 위험이 높으므로 공격적인 수술 치료가 필요하다는 "매"파와 악성의 위험이 있지만 과도하게 치료할 위험이 훨씬 더 높다고 주장하는 "비둘기"파가 있다. 췌장수술은 28-30%의 이환율과 1%의 사망률로 고위험 수술이기 때문에 작은 췌장 신경내분비종양에 대한 치료 결정은 어렵다.

Keywords

Acknowledgement

This study was supported by National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIP) (No. NRF-2019R1C1C1006851 and -2019R1F1A1042044).

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