Abstract. Results from a retrospective review demonstrated significant increases in the use of observation in patients with small nonfunctional pancreatic neuroendocrine tumors (NF-pNETs) from 2015 to 2020, as published in JAMA Surgery.  Researchers also found that patients seen at academic centers were more likely to undergo observation compared with those seen at nonacademic centers.

Currently, experts are uncertain of the metastatic potential of NF-pNETs, and the potential morbidity linked with pancreatic surgery, as noted in the study. This may be associated with patients opting for surgery vs active surveillance, although recent guidelines endorse the use of active surveillance backed by retrospective data.

The study stated:

Nonfunctional pancreatic neuroendocrine tumors (NF-pNETs) are often diagnosed incidentally. While many remain clinically indolent, others demonstrate a propensity to metastasize. Increasing evidence supports active surveillance for small (≤2 cm), low-grade NF-pNETs.¹ Over the last decade, this has been reflected in guidelines.^2–4 We assessed nationwide trends in the use of observation for pNETs ≤2 cm and to evaluate factors associated with resection.

The entire text of the study is behind a paywall for now but you can read what is available at Reference 2.  Reference 1 contains a larger abstract.  Reference 3 is available online – see page PanNET-1 and follow guidance.  Login required. 

Clearly more research is required on risk management of surgery vs  watching these tumours.