Pancreatic neuroendocrine tumors - going beyond surgery. Literature review and experience of a tertiary center.

Background: Surgery is the standard therapy for pancreatic neuroendocrine tumors (pNETs), but since post-resection fistulae and other surgery related complications are common, new minimal invasive approaches are emerging. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is a promising tool for pNETs, with a good safety profile and favorable results.

Methods: This is a single-center, retrospective case series including all patients with functional (F) and non-functional (NF) pNETs treated with EUS-RFA in the Department of Gastroenterology, Emergency Clinical Hospital of Bucharest, Romania, between March 2023 and March 2024 and followed for a mean period of 11.6 months. Technical success, clinical, sonographic and radiological response, adverse events (AEs) rate and severity were assessed. Methods: A total of five out of nine EUS-RFA were performed for pNETs, with a majority of NF-pNETs. In this pNET group, the mean size of the lesions was 13 mm. Technical success was achieved in 100% of patients and persistent clinical remission of hypoglycemia in the insulinoma case was attained. In the NF-pNET subgroup, two patients were successfully radiologically treated with complete disappearance of the lesions, one lesion showed cystic transformation, and one had modest size reduction at follow-up imagery. One procedure-related early AE occurred: mild abdominal pain with quick resolution. No major complications, nor death were reported.

Conclusions: Reports from this literature review and small case series suggest that EUS-RFA can be effective in both F- and NF-pNETs, offering the best combination of real-time imaging guidance and minimal invasiveness with no severe AEs and short hospital stay.