Optimal Lymphadenectomy in Small Bowel Neuroendocrine Tumors: Analysis of the NCDB

Motz, B.; Lorimer, Patrick D.; Boselli, Danielle; Hill, Joshua S.; Salo, Jonathan C.

doi:10.1007/s11605-017-3524-9

Cited by 31 publications

(37 citation statements)

References 21 publications

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“…In the United States, the small intestine is the third most prevalent primary site of NET, following rectum and lung, and NET is the most common neoplasm arising in the small intestine, followed by adenocarcinoma and lymphoma . Ileal NET (i‐NET) accounts for 90% of small intestinal NETs (excluding duodenal origin) …”

Section: Introductionmentioning

confidence: 99%

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Prognostic impact of a large mesenteric mass >2 cm in ileal neuroendocrine tumors

Kasai

Mahuron

Hirose

et al. 2019

Journal of Surgical Oncology

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Background and Objectives Ileal neuroendocrine tumors (i‐NETs) frequently metastasize to mesenteric lymph nodes and the liver. Regional lymphadenopathy is associated with desmoplasia of the mesentery forming a large mesenteric mass (LMM). Although the latest American Joint Committee on Cancer TNM staging (8th edition) defined LMM >2 cm as N2, the prognostic impact of LMM is ill‐defined. We evaluated whether LMM is prognostic for patients with i‐NETs. Methods This single‐institution, retrospective cohort study included 106 patients who underwent resection of i‐NETs between 2007 and 2018. Overall survival (OS) and liver progression‐free survival (LPFS) were compared between patients with and without LMM. Results LMM was present in 66 patients (62%) and was not associated with the presence or absence of liver metastasis (P = .969) or the extent of liver involvement (P = .938). OS and LPFS differed significantly between patients with and without LMM (5‐year OS rates of 64.8% and 92.9%, respectively, P = .011; 3‐year LPFS rates of 45.3% and 67.5%, respectively, P = .025). In multivariate analysis, LMM was an independent prognostic factor for both OS (hazard ratio: 4.69, 95% confidence interval: 1.63‐17.6) and LPFS (1.99, 1.08‐3.88). Conclusion LMM >2 cm is prognostic for OS and LPFS and represents aggressive tumor biology.

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Section: Introductionmentioning

confidence: 99%

“…Because i‐NETs are asymptomatic at an early stage, they are frequently diagnosed at an advanced stage with metastases involving regional lymph node (34%‐88%) and the liver (56%‐78%) . Regional lymphadenopathy is associated with desmoplasia of the mesentery forming a mesenteric mass .…”

Section: Introductionmentioning

confidence: 99%

Prognostic impact of a large mesenteric mass >2 cm in ileal neuroendocrine tumors

Kasai

Mahuron

Hirose

et al. 2019

Journal of Surgical Oncology

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“…They believe that the best lymph node dissection is not simply a prolonged small bowel resection, but that the classi cation of mesenteric LNs should be standardized to help standardize the management of NET patients. According to Benjamin M Motz's report 21 , about 20% of patients with small bowel cancer resection from The National Cancer Database have not received lymph node dissection, although this can bring some benign effects.…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of lymph node dissection on stage-specific survival for patients with primary small intestine tumor treated with enterectomy: A population-based study, 2004-2015

Chen

Guo

et al. 2020

Preprint

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Background: The positive rate of lymph node detection(LND) can be used as a predictor of prognosis for patients undergoing radical resection of small bowel tumors; thorough local LND may be crucial for the accurate staging and management of the disease.The purpose of our study was to determine the effect of the LND in specific stages. Methods: This study included 5413 patients with primary small intestine tumors after enterectomy within SEER database from 2004-2015. A multivariable COX model and Kaplan-Meier plots survival curves were used to analyze survival.Results: Of the 5413 patients, 4675(86.4%) underwent lymphadenectomy, and 3896(72.0%) were moved 4 or more than 4 lymph nodes. LND was performed in 67.8%, 83.3%, 87.9%, 89.3% in pT1/2/3/4 disease. In multivariable Cox regression analyses, LND was associated with OS and CSS, and the extended LND are better than limited LND (all P<0.05 except pT2). Kaplan-Meier plots survival curves showed that LND can benefit patients.Conclusions: The removal of LND with 4 or more lymph nodes in pT1/3/4 patients has relatively obvious benefits for survival. The effect of LND with more lymph nodes is significantly better than limited LND. For pT1, pT3 and pT4, LND can be considered.

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“…Surgeons must be informed that lymphadenectomy is always required in SI-NET surgery. Retrospective registry analyses have suggested that at least 8 (or possibly 12) removed lymph nodes are needed to improve overall survival [7][8][9]. Moreover, French guidelines have suggested discussing a 're-intervention' after postoperative evaluation by FDOPA-PET or 68 Ga-PET if fewer than 8 lymph nodes have been resected [25].…”

Section: Surgery Of Mlnmmentioning

confidence: 99%

“…SI-NET primary tumors are usually small (<20 mm), distal in the ileum, and multiple in 30% to 50% of cases [ 4 , 5 , 6 ]. Mesenteric lymph node metastases (MLNM) are present in more than 80% of patients at diagnosis, regardless of the size of the primary tumor [ 7 , 8 , 9 , 10 , 11 ]. MLNM are typically larger than primary tumors and associated with dense desmoplastic fibrosis leading to retractile mesenteritis.…”

Section: Introductionmentioning

confidence: 99%

Surgery and Perioperative Management in Small Intestinal Neuroendocrine Tumors

Deguelte¹,

Perrier²,

Hammoutene³

et al. 2020

JCM

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Small-intestinal neuroendocrine tumors (SI-NETs) are the most prevalent small bowel neoplasms with an increasing frequency. In the multimodal management of SI-NETs, surgery plays a key role, either in curative intent, even if R0 resection is feasible in only 20% of patients due to advanced stage at diagnosis, or palliative intent. Surgeons must be informed about the specific surgical management of SI-NETs according to their hormonal secretion, their usual dissemination at the time of diagnosis and the need for bowel-preserving surgery to avoid short bowel syndrome. The aim of this paper is to review the surgical indications and techniques, and perioperative and postoperative management of SI-NETs.

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Optimal Lymphadenectomy in Small Bowel Neuroendocrine Tumors: Analysis of the NCDB

Cited by 31 publications

References 21 publications

Prognostic impact of a large mesenteric mass >2 cm in ileal neuroendocrine tumors

Prognostic impact of a large mesenteric mass >2 cm in ileal neuroendocrine tumors

Prognostic significance of lymph node dissection on stage-specific survival for patients with primary small intestine tumor treated with enterectomy: A population-based study, 2004-2015

Surgery and Perioperative Management in Small Intestinal Neuroendocrine Tumors

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