Surgical Treatment of NEN of Small Bowel: A Retrospective Analysis

Watzka, Felix; Fottner, Christian; Miederer, Matthias; Weber, Matthias M.; Schad, Arno; Lang, Hauke; Musholt, Thomas J.

doi:10.1007/s00268-016-3432-2

Cited by 43 publications

(49 citation statements)

References 24 publications

(29 reference statements)

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“…A systematic lymphadenectomy (at least >8 resected nodes) is associated with a significantly better survival compared with selective lymphadenectomy [50,51] . It should be pointed out that these findings were not corroborated by other studies [3,47] .…”

Section: What Is the Minimal Number Of Lymph Nodes To Be Harvested Dumentioning

confidence: 99%

“…These complications are often associated with significant morbidity in addition to the release of peptides leading to the carcinoid syndrome [23] . In experienced centres, a complete resection of primary tumour and regional mesenteric nodal metastases can be achieved in up to 80% of cases [7,12,50] . Only in a minority of patients can large mesenteric mass lesions not be completely resected or debulked [7] .…”

Section: Which Is the Role Of Surgery For Borderline Resectable Or Lomentioning

confidence: 99%

“…The rate of surgical complications has been reported to be between 7.5 and 30% with a mortality rate of 1-1.5% [12,48,50] . The difference in terms of postoperative morbidity and mortality rates between high-volume and low-volume centres may not be firmly evaluated [48] .…”

Section: Postoperative Complicationsmentioning

confidence: 99%

See 2 more Smart Citations

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumours: Surgery for Small Intestinal and Pancreatic Neuroendocrine Tumours

Partelli

Bartsch²,

Capdevila³

et al. 2017

Neuroendocrinology

254

260

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The small intestine and pancreas are among the most frequent abdominal sites of origin of neuroendocrine tumours. Distinctive features of these forms are represented by the relatively low incidence and the wide heterogeneity in biological behaviour. In this light, it is difficult to standardize indications for surgery and the most appropriate approach. It would be helpful for surgeons managing patients with these tumours to have guidelines for surgical treatment of small intestinal neuroendocrine tumours and pancreatic neuroendocrine tumours. The proposed guidelines represent a consensus of the working group of the European Neuroendocrine Tumor Society (ENETS).

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Section: What Is the Minimal Number Of Lymph Nodes To Be Harvested Dumentioning

confidence: 99%

Section: Which Is the Role Of Surgery For Borderline Resectable Or Lomentioning

confidence: 99%

See 1 more Smart Citation

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumours: Surgery for Small Intestinal and Pancreatic Neuroendocrine Tumours

Partelli

Bartsch²,

Capdevila³

et al. 2017

Neuroendocrinology

254

260

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“…Although fewer than 40% of tumors are multifocal, intraoperative inspection and palpation of the whole small bowel is considered of utmost importance (19).…”

Section: Locoregional Enterectomy With Lymph Node Dissectionmentioning

confidence: 99%

“…Lymphadenectomy should precede enterectomy with possible ileoceccal valve preservation (10,18,28,35). R0 resection of both primary tumor and lymph node metastases is feasible in 80% of cases (10,18,19,36). Only in a minority of patients with bulky mesenteric masses is optimal debulking not feasible (36).…”

Section: Mesenteric Lymph Node Metastases and Desmoplastic Fibrosismentioning

confidence: 99%

Update on Surgical Management of Small Bowel Neuroendocrine Tumors

Moris

Ntanasis‐Stathopoulos

Tsilimigras

et al. 2018

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Prognostic Role of Lymph Node Positivity and Number of Lymph Nodes Needed for Accurately Staging Small-Bowel Neuroendocrine Tumors

et al. 2019

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IMPORTANCE Little information is available regarding the minimum number of lymph nodes needed to accurately stage patients when performing a mesenteric lymphadenectomy for small-bowel neuroendocrine tumors. OBJECTIVES To determine the prognostic role of lymph node positivity and the ideal number of lymph nodes for accurately staging patients with small-bowel neuroendocrine tumors. DESIGN, SETTING, AND PARTICIPANTS This case series from the US Neuroendocrine Tumor Study Group, a collaboration among 8 US-based, academic tertiary care referral centers, obtained demographic, perioperative, and pathologic data from the group's database, Social Security Death Index, and publicly available obituaries. All patients in these institutions with small-bowel neuroendocrine tumors who underwent curative-intent surgical resection of a primary tumor between January 1, 2000, and December 31, 2015, were included (n = 199). Patients with duodenal or ampullary tumors, other nonneuroendocrine concurrent malignant neoplasms, mortality of fewer than 30 days after the surgical procedure, and distant metastatic disease were excluded. Data analysis was conducted from September 1, 2017, to December 1, 2017. MAIN OUTCOMES AND MEASURES Primary study outcome was recurrence-free survival. Hypothesis was generated after data collection and data entry into the US Neuroendocrine Tumor Study Group database. RESULTS Of the 199 patients included, 112 (56.3%) were male and 87 (43.7%) female with a mean (SD) age of 60.3 (12.5) years and a mean (SD) body mass index of 29.5 (6.0). One hundred fifty-four patients (77.4%) had lymph node-positive disease. No difference in 3-year recurrence-free survival was found between patients with lymph node-positive and lymph node-negative disease. Patients with 4 positive lymph nodes had a worse 3-year recurrence-free survival compared with those with 1 to 3 or 0 positive lymph nodes (81.6% vs 91.4% vs 92.1%; P = .01). When examining patients with fewer than 8 resected lymph nodes, no difference in 3-year recurrence-free survival was observed among patients with 4 or more, 1 to 3, or 0 positive lymph nodes (100% vs 93.8% vs 91.7%; P = .87). Retrieval of 8 or more lymph nodes, however, accurately discriminated patients with 4 or more, 1 to 3, or 0 positive lymph nodes (3-year recurrence-free survival: 79.9% vs 89.6% vs 92.9%; P = .05). CONCLUSIONS AND RELEVANCE The findings from this study suggest that, for patients undergoing curative-intent resection of small-bowel neuroendocrine tumors, accurate lymph node staging requires a minimum of 8 lymph nodes for examination, and 4 or more positive lymph nodes are associated with decreased 3-year recurrence-free survival compared with 1 to 3 or 0 positive lymph nodes; a thorough regional lymphadenectomy may be critical for accurate staging and management of this disease.

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Surgical Treatment of NEN of Small Bowel: A Retrospective Analysis

Abstract: Mesenteric lymph node metastases are almost invariably present and have significant impact on patients' prognosis. Systematic lymphadenectomy prevents complications and improves the survival. Early surgical treatment should be the goal in order to prevent complications.

Cited by 43 publications

References 24 publications

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumours: Surgery for Small Intestinal and Pancreatic Neuroendocrine Tumours

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumours: Surgery for Small Intestinal and Pancreatic Neuroendocrine Tumours

Update on Surgical Management of Small Bowel Neuroendocrine Tumors

Prognostic Role of Lymph Node Positivity and Number of Lymph Nodes Needed for Accurately Staging Small-Bowel Neuroendocrine Tumors

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