Survival of patients with small bowel neuroendocrine neoplasms in Auckland, Aotearoa New Zealand

Abstract

Background Small intestinal Neuroendocrine Neoplasms (SI‐NENs) are the most common primary malignancy of the small bowel. The aim of this study is to define the survival of patients with an SI‐NEN in Auckland, Aotearoa New Zealand (AoNZ). Methods A retrospective study of all patients diagnosed with a jejunal or ileal SI‐NEN in the Auckland region between 2000 and 2012 was performed. The New Zealand NETwork! Registry was searched to identify the study cohort. Retrospective data collection was performed to collect stage, survival and follow up data. Results One hundred and seven patients were included in the study. The mean age of patients was 62.8 years (SD 11.9). The 5 and 10‐year disease‐specific survival for all patients was 66.1% (95% CI 56.5–75.7%) and 61.8% (95% CI 51.8–71.8%), respectively. Ten‐year disease‐specific survival was 100% for stage I and II, 74% (95%CI 61.7–84.4%) for stage III and 33.9% (95%CI 16.9–35.6%) for stage IV SI‐NEN. Eleven of 40 (27.5%) patients with stage III disease had recurrence and 3 of 7 (42.8%) patients with stage IV disease had recurrence. In patients with stage IV disease, neither primary resection (HR 2.25, 95% CI 0.92–5.5) nor distant resection (HR 1.72, 95% CI 0.63–4.7) were significantly associated with a disease‐specific or overall survival benefit. Conclusion This study demonstrates that stage at SI‐NEN diagnosis is associated with survival, but resection of the primary or distant metastases in patients with stage IV disease is not. There was no recurrence in patients with stage I or II disease after complete resection.

Small bowel neuroendocrine tumours – casting the net wide

“…This tumour may also be well differentiated or poorly differentiated [98][99][100]. WHO stage and number of lymph nodes involved has prognostic implications in patients with small bowel NET [49,[101][102][103][104][105][106].…”

Surgery as a Principle and Technical Consideration for Primary Tumor Resection of Small Bowel Neuroendocrine Tumors

“…Locoregional SB-NETs can be treated with curative intent, with risk of recurrence, while metastatic SB-NETs can rarely be cured even if they can be treated with prolonged survival with persistent disease. 54 , 59 , 61 , 62 In the latter setting, surgical palliation or pre-emptive surgery to avoid future complications (i.e., mesenteric stenosis or bowel ischemia) may be indicated, although this is still debated for its impact on overall survival.…”

“…As many as one in every two patients with mesenteric nodal masses present with abdominal pain or intestinal obstruction, and resection of the mesenteric mass can provide relief of symptoms and prolonged survival. 12 , 59 , 61 When the nodal mass is large or extending proximally along the axis of the SMA (such as level 2 and 3 masses), a mesenteric-sparing resection may be needed to resect the bulk of the mass. An R1 margin is then accepted, considering the need to prevent debilitating fibrosis-related complications while avoiding short bowel syndrome and the indolent growth of NETs, making recurrence at the R1 margin unlikely or extremely low over the course of disease.…”