The incidence of pancreatic neuroendocrine tumors (PNETs) has risen more than 6-fold over the last several decades, likely because of widespread use of advanced imaging studies for abdominal complaints. A subject of ongoing controversy is how to best manage small (≤2 cm), incidentally discovered PNETs. Although most PNETs behave in an indolent fashion, some lesions will manifest more aggressive behavior. Surgical procedures play a pivotal role in the management of these tumors, as they represent the only curative treatment. Although most surgeons would advocate for resection of all functional PNETs (those causing a syndrome), recommendations to resect or observe asymptomatic or nonfunctional (NF) PNETs 2 cm or smaller vary based on data from different studies. This Viewpoint highlights the issues surrounding management strategies for patients with small NF-PNETs.
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Aziz H, Howe JR, Pawlik TM. Surgery vs Observation for Patients With Small Pancreatic Neuroendocrine Tumors. JAMA Surg. Published online January 13, 2021. doi:10.1001/jamasurg.2020.5640
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