Pankreasın Endokrin Hastalıklarında Cerrahi Yaklaşımlar
Özet
Pankreas nöroendokrin tümörleri (pNET), insülinoma ve gastrinoma gibi fonksiyonel veya nonfonksiyonel tümörlerden oluşan heterojen bir gruptur ve tüm pankreas tümörlerinin %1-2'sini kapsar. Tanıda klinik semptomlar, biyokimyasal analizler ile ultrasonografi, BT, MR ve EUS gibi kesitsel görüntüleme yöntemleri kritik rol oynar. pNET'lerin tedavisinde cerrahi yaklaşım; tümörün fonksiyonel durumuna, boyutuna, lokalizasyonuna ve MEN-1 sendromuyla ilişkisine göre kişiselleştirilir. 2 cm'den küçük, ana pankreas kanalına uzak sporadik insülinomalarda enükleasyon parankim koruyucu bir seçenekken; gastrinoma, glukagonoma ve malignite riski yüksek diğer tümörlerde veya ana kanala yakın yerleşimlerde standart radikal rezeksiyonlar (distal pankreatektomi, pankreatikoduodenektomi) ve lenfadenektomi uygulanır. Karaciğer metastazlarında cerrahi rezeksiyon G1-G2 tümörlerde önerilir. Son dekatta laparoskopik ve robotik gibi minimal invaziv cerrahi yaklaşımlar, açık cerrahiye kıyasla daha az kan kaybı ve hızlı iyileşme avantajlarıyla öne çıkmaktadır. Postoperatif takip, nüks riski nedeniyle fonksiyonel tümörlerde ilk 3 yıl 6-12 ayda bir, nonfonksiyonel olanlarda ise daha sık aralıklarla kesitsel görüntüleme ve hormon panelleriyle yaşam boyu sürdürülmelidir.
Pancreatic neuroendocrine tumors (pNETs) are a heterogeneous group of functional tumors, such as insulinomas and gastrinomas, and nonfunctional tumors, accounting for 1-2% of all pancreatic neoplasms. Diagnosis relies heavily on clinical symptoms, biochemical analyses, and cross-sectional imaging modalities including ultrasound, CT, MRI, and EUS. Surgical management of pNETs is highly customized based on tumor functionality, size, localization, and association with MEN-1 syndrome. Parenchymal-sparing enucleation is preferred for sporadic insulinomas smaller than 2 cm located away from the main pancreatic duct, whereas standard radical resections (distal pancreatectomy, pancreaticoduodenectomy) combined with lymphadenectomy are performed for gastrinomas, glucagononmas, large nonfunctional tumors, or lesions close to the main duct. Surgical resection is recommended for liver metastases in G1-G2 tumors. Over the past decade, minimally invasive surgical approaches, including laparoscopic and robotic surgery, have gained prominence due to advantages like reduced intraoperative blood loss and shorter hospital stays compared to open surgery. Postoperative lifelong follow-up is essential using cross-sectional imaging and hormonal evaluations, scheduled every 6-12 months for functional tumors and 3-6 months for nonfunctional tumors during the first three years.
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