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Owing to their incapacity to produce hormone\u2010dependent symptoms, NFNEPTs are detected incidentally or because of uncharacteristic symptoms resulting from local or distant growth. About two\u2010thirds of NFNEPTs are located in the pancreatic head, so jaundice may be a late symptom of this tumor. Modern diagnostic procedures are best applied by a stepwise approach: first endoscopic ultrasonography and computed tomography\/magnetic resonance imaging followed by somatostatin receptor scintigraphy or positron emission tomography (or both). Due to significant false\u2010positive and false\u2010negative findings, for decision\u2010making the latter should be confirmed by a second imaging modality. Regarding indications for surgery and the surgical approach to the pancreas, three pancreatic manifestations of NFNEPTs can be distinguished: (1) solitary benign non\u2010multiple endocrine neoplasia type 1 (non\u2010MEN\u20101); (2) multiple benign MEN\u20101; and (3) malignant NFNEPTs. Reviewing the literature and including our experience with 18\u00a0NFNEPTs (8 benign, 10\u00a0malignant) reported here, the following conclusions can be drawn: (1) Solitary benign non\u2010MEN\u20101\u00a0NFNEPTs can be removed by enucleation or by pancreas\u2010, spleen\u2010, and duodenum\u2010preserving techniques in most cases. The choice of surgical technique depends on the location and site of the tumor and its anatomic relation to the pancreatic duct. (2) With multiple benign MEN\u20101\u00a0NFNEPTs, because of the characteristics of the underlying disease a preferred, more conservative concept (removal of only macrolesions) competes with a more radical procedure (left pancreatic resection with enucleation of head macrolesions). Further studies are necessary to clarify the best way to balance quality of life (by preserving organ function) with growth control of potentially malignant tumors in the pancreas. (3) Malignant NFNEPTs comprise more than half of all NFNEPTs. Few studies have analyzed treatment strategies for localized or metastatic tumors. Whereas radical (including multivisceral) resection of tumors without distant metastases is widely accepted, the indication for radical surgery on metastasizing tumors has been questioned, as radical removal of the primary tumor may fail to increase survival. Adjuvant regimens in these tumor stages are mandatory and should be further optimized.<\/jats:p>","DOI":"10.1007\/s00268-004-7609-8","type":"journal-article","created":{"date-parts":[[2004,11,5]],"date-time":"2004-11-05T17:17:42Z","timestamp":1099675062000},"page":"1248-1260","source":"Crossref","is-referenced-by-count":85,"title":["Surgery of Resectable Nonfunctioning Neuroendocrine Pancreatic Tumors"],"prefix":"10.1002","volume":"28","author":[{"given":"Henning","family":"Dralle","sequence":"first","affiliation":[{"name":"Department of General, Visceral, and Vascular Surgery, Medical Faculty University of Halle\u2010Wittenberg Halle\/Saale, Ernst\u2010Grube\u2010Strasse 40 D\u201006097 Halle Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabine L.","family":"Krohn","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, and Vascular Surgery, Medical Faculty University of Halle\u2010Wittenberg Halle\/Saale, Ernst\u2010Grube\u2010Strasse 40 D\u201006097 Halle Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolfram","family":"Karges","sequence":"additional","affiliation":[{"name":"Department of International Medicine, Section of Endocrinology, Medical Faculty University of Ulm Robert\u2010Koch\u2010Strasse 8 D\u201089081 Ulm Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernhard O.","family":"Boehm","sequence":"additional","affiliation":[{"name":"Department of International Medicine, Section of Endocrinology, Medical Faculty University of Ulm Robert\u2010Koch\u2010Strasse 8 D\u201089081 Ulm Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Brauckhoff","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, and Vascular Surgery, Medical Faculty University of Halle\u2010Wittenberg Halle\/Saale, Ernst\u2010Grube\u2010Strasse 40 D\u201006097 Halle Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver","family":"Gimm","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, and Vascular Surgery, Medical Faculty University of Halle\u2010Wittenberg Halle\/Saale, Ernst\u2010Grube\u2010Strasse 40 D\u201006097 Halle Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2004,11,11]]},"reference":[{"key":"e_1_2_9_2_2","first-page":"208","volume-title":"Endocrine tumors of the pancreas, Frontiers in Gastrointestinal Research","author":"Eriksson B","year":"1995"},{"key":"e_1_2_9_3_2","first-page":"361","volume-title":"Surgical Endocrinology","author":"Hochwald SN","year":"2001"},{"key":"e_1_2_9_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800800528"},{"key":"e_1_2_9_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0046-8177(82)80183-4"},{"key":"e_1_2_9_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01297144"},{"key":"e_1_2_9_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0748-7983(97)80140-0"},{"key":"e_1_2_9_8_2","first-page":"573","article-title":"Nonfunctioning islet cell tumors of the pancreas: a difficult diagnosis but one worth the effort","volume":"63","author":"Madura JA","year":"1997","journal-title":"Am. 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