Surgery and Perioperative Management in Small Intestinal Neuroendocrine Tumors

Abstract

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.

Neuroendocrine liver metastasis from the small intestine: Is surgery beneficial for survival?

“…In current guidelines detailed information is published on systemic therapy [18]. However recommendations for surgery in asymptomatic or minimally symptomatic patients with liver metastasis are lacking [20,21]. Recently a benefit of surgery of liver metastasis of neuroendocrine neoplasia of the pancreas was shown in regard to overall survival, however there is little data on siNENs [22].…”

Ileal neuroendocrine tumor: diagnosis by endoscopic capsule

“…Despite the various techniques for evaluating the small intestine, in patients with small lesions, routine exams including CT, MR enteroclysis, and CE often give negative results in preoperative work-up. Besides, none of them can replace the manual bowel palpation at the surgery's time for detection of the small lesions (Deguelte et al, 2020). Studying 56 patients with preoperative CT scans and 47 with SRS, CT localized a primary NET of small bowel in 27 of 56 (48 %) and nodal metastases in 33 of 56 (79 %).…”

“…After a careful revision of the small bowel diseases small bowel diseases excised tumor with the loco-regional lymph nodes, the patient underwent an enlargement of the surgical margin and lymphadenectomy. NETs were considered rare; however, with the advancement and availability of new diagnostic modalities such as the endoscopic capsule, an increasing number of this neoplasia has been diagnosed (Ahmed, 2020;Deguelte et al, 2020;Folkestad et al, 2020;Levy et al, 2020).…”

“…The majority of NETs are found in the GI and bronchopulmonary locations (Ahmed, 2020). The small intestine is not the most frequent area of NETs but is the most common primary site giving origin to distant metastases (Ahmed, 2020;Deguelte et al, 2020). The majority of tumors are non-functioning and usual manifestations are abdominal pain, partial intestinal obstruction, and hemorrhage (Ahmed, 2020;Deguelte et al, 2020;Folkestad et al, 2020;Kamei et al, 2020).…”

“…Neuroendocrine tumors (NETs) origin in enterochromaffin cells of the gastrointestinal (GI) tract, and small intestinal NETs (SI-NETs) arise from the submucosal crypts (Ahmed, 2020). Even with a slow growth, they usually have metastases at the time of diagnosis (Deguelte et al, 2020;Folkestad et al, 2020, Levy et al, 2020. There is a genetic influence in their etiology associated with deleting of the tumor suppressor gene PLCβ3 that causes uncontrolled growth of the neuroendocrine cells (Kamei et al, 2020).…”