Management of pancreatic neuroendocrine tumours (P-NETs) remains a challenge in multiple endocrine neoplasia type 1 (MEN1). Sadowski et al. have provided an excellent overview of the literature, which helps decision-making in this field.

One take home message for me was that P-NETs <2cm and stable can be observed. Endoscopic ultrasound has a better pick-up rate than magnetic resonance imaging (MRI) for P-NETs. If seen on both modalities, MRI can be used for surveillance every 1–3 years. Liver MRI remains the best imaging modality for detecting liver metastases and there is no evidence to support use of Gallium-68 positron emission tomography in surveillance strategies. We need to be mindful of long term surveillance strategies and radiation dosing, and increasing anxiety, particularly in young patients.

In terms of surgery, all seem to agree that total pancreatectomy is not advisable. Whilst some advocate aggressive procedures such as distal pancreatectomy, head of pancreas enucleation and duodenectomy, there has been high risk of complications. Most surgeons favour a more conservative approach, accepting that repeat surgery may be necessary.

Again, the French seem to lead the field with national registries. Without nationwide long term observational clinical data, we will not understand which interventions work and improve outcomes for our patients.

Read the full article in Endocrine-Related Cancer 24 T243–T260.