Indications

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• Tumors may be functional (ie, a clinical syndrome of excessive levels of such hormones as insulin, gastrin, VIP, somatostatin, and glucagon) or nonfunctional (ie, normal serum marker levels [excluding pancreatic polypeptide, chromogranin A]).
  
• Tumors may be sporadic or a manifestation of an inherited endocrinopathy (multiple endocrine neoplasia type 1 [MEN-1], von Hippel-Lindau [VHL]).
  
• Nonfunctional tumors demonstrable via radiologic examination should be resected.
  
• All functional tumors should be resected.
  
• Sinistral portal hypertension.

Contraindications

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• Inoperable, metastatic disease.
  
• Small (< 1 cm), nonfunctional tumors in patients with an inherited endocrinopathy.
  
• Functional tumors with a medically controlled syndrome in patients with an inherited endocrinopathy who have undergone previous pancreatic resection.
  
• Pregnancy (first trimester).
  
• Multiple comorbidities precluding safe surgical intervention.

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