Surgical approach

Multidisciplinary work-up and high-volume centers' experience are the key element in the management of neuroendocrine neoplasms (NENs). Surgery should be individualized on the basis of symptoms at presentation, tumor, type, extent of the disease, available prognostic factors and association with hereditary disease such as multiple endocrine neoplasia type 1. Endoscopic procedures are a valid alternative to surgery for small gastric and rectal NENs. Parenchyma-sparing procedure might be considered in benign or uncertain behavior pancreatic NENs. Both curative and debulking surgery can be considered in the treatment of advanced NENs.