Surgery of the Endocrine Pancreas
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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.
- 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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