Chirurgische Aspekte bei kleinen neuroendokrinen Dünndarmtumoren

Abstract

Neuroendocrine tumors of the small intestines are a rare disease with an incidence of 1 per 100,000 of the population; however, they account for over 20% of all neuroendocrine tumors and are the most common malignancy of the small intestines. Diagnosis is often made at a late stage of the disease, as the clinical symptoms are unspecific. Approximately one third of all patients show hepatic metastases at the time of diagnosis. There is no correlation between tumor size and tumor stage. Even small tumors <10 mm harbor the risk for lymphatic and distant metastases so that the extent of surgery is not determined by the size of the primary tumor. The intestinal-sparing resection with systematic lymphadenectomy along the superior mesenteric artery and removal of the retropancreatic lymph nodes is recommended even in localized stages of the disease.

Prior Resection of the Primary Tumor Prolongs Survival After Peptide Receptor Radionuclide Therapy of Advanced Neuroendocrine Neoplasms

“…The SI is one of the most common origins of NEN, with terminal ileum close to the ileocoecal valve being the most common location 41,42 . The resection of the primary SI-NEN has been debated for years 43 . As reported previously, surgically treated patients performed better and had longer OS 41,44,45 …”

“…Until now, prospective data concerning this issue are lacking. Many surgical studies recommend prophylactic hemicolectomy with standard lymphadenectomy around the mesenteric root 32,43 . Even SI-NETs smaller than 2 cm often present with local lymph node and even distant lymph node metastasis as reported by Walsh et al 46 The SI-NENs are characterized by mesenteric fibrosis, which can lead to intestinal obstruction, ischemia, and ileus.…”