{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:05:04Z","timestamp":1792098304376,"version":"4.4.0"},"reference-count":81,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2015,3,13]],"date-time":"2015-03-13T00:00:00Z","timestamp":1426204800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Hepato Biliary Pancreat"],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Pancreatic neuroendocrine tumors (pNETs) include functioning and non\u2010functional tumors. Functioning tumors consist of tumors that produce a variety of hormones and their clinical effects. Therefore, determinants of resection of pNETs should be discussed for each group of tumors. Less than 10% of insulinomas are malignant, therefore more than 90% of the cases can be cured by surgical resection. Lymphadenectomy is generally not necessary in insulinoma operation. If preoperative localization of the insulinoma is completed, enucleation from the pancreatic body or tail, and distal pancreatectomy can be performed safely by laparoscopy. When preoperative localization of a sporadic insulinoma is not confirmed, surgical exploration is needed. Intraoperative localization of a tumor, intraoperative insulin sampling and frozen section are required. The crucial purpose of surgical resection is to control inappropriate insulin secretion by removing all insulinomas. Gastrinomas are usually located in the duodenum or pancreas, which secrete gastrin and cause Zollinger\u2010Ellison syndrome (ZES). Duodenal gastrinomas are usually small, therefore they are not seen on preoperative imaging studies or endoscopic ultrasound, and can be found only at surgery if a duodenotomy is performed. In addition, lymph node metastasis is found in 40\u201360% of cases. Therefore, the experienced surgeons should direct operation for gastrinomas. Surgical exploration with duodenotomy should be performed at a laparotomy. Other functioning pNETs can occur in the pancreas or in other locations. Curative resection is always recommended whenever possible after optimal symptomatic control of the clinical syndrome by medical treatment. Indications for surgery depend on clinical symptom control, tumor size, location, extent, malignancy and presence of metastasis. A lot of non\u2010functioning pNETs are found incidentally according to the quality improvement of imaging techniques. Localized, small, malignant non\u2010functioning pNETs should be operated on aggressively, while in possibly benign tumors smaller than 2 cm the surgical risk\u2010benefit ratio should be carefully weighted. Surgical liver resection is generally proposed in curative intent to all patients with operable metastases from G1 or G2 pNET. The benefits of surgical resection of liver metastases have been demonstrated in terms of overall survival and quality of life. Complete resection is associated with better long\u2010term survival.<\/jats:p>","DOI":"10.1002\/jhbp.224","type":"journal-article","created":{"date-parts":[[2015,3,14]],"date-time":"2015-03-14T00:55:35Z","timestamp":1426294535000},"page":"610-617","source":"Crossref","is-referenced-by-count":34,"title":["Determinants of surgical resection for pancreatic neuroendocrine tumors"],"prefix":"10.1002","volume":"22","author":[{"given":"Ryuichiro","family":"Doi","sequence":"first","affiliation":[{"name":"Department of Surgery Otsu Red Cross Hospital  1\u20101\u201035 Nagara Otsu Shiga 520\u20108511 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