The Landmark Series: Management of Small Bowel Neuroendocrine Tumors

Tran, Catherine; Sherman, Scott K.; Howe, James R.

doi:10.1245/s10434-020-09566-4

Cited by 19 publications

(12 citation statements)

References 73 publications

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“…10 Hence, these tumors can be associated with a mesenteric desmoplastic reaction, resulting in GI obstruction. 3,11 A mesenteric inflammatory reaction that, if allowed to persist, might have progressed to a desmoplasia could also cause recurrent obstructions in this patient. However, no fibrosis was appreciated on exploratory laparotomy.…”

Section: Discussionmentioning

confidence: 88%

Recurrent Gastrointestinal Pseudo-obstruction Because of Well-Differentiated Duodenal Neuroendocrine Tumor

et al. 2022

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A 56-year-old man presented with recurrent gastrointestinal obstruction. Computed tomography showed fluid-filled, distended stomach, small intestine, and large intestine. Extensive workup including esophagogastroduodenoscopy, colonoscopy, magnetic resonance enterography, push enteroscopy, and video capsule enteroscopy showed no mechanical obstruction. Endoscopic ultrasound-guided biopsy of peripancreatic nodes detected on 18 F-fluorodeoxyglucose positron emission tomography revealed a duodenal neuroendocrine tumor. The lesion showed intense uptake on gallium-68 DOTATOC positron emission tomographycomputed tomography scan. The patient underwent surgical resection of the tumor with resolution of bowel obstruction events. He had elevated pancreatic polypeptide levels, which are known to delay gastric emptying and could explain his symptoms.Previous computed tomography (CT) scans of the abdomen showed variable distension of the stomach, or fluid-filled small intestine with concern for transition point at the ileum, or distended large intestine. He had formerly undergone 2 esophagogastroduodenoscopies, which did not reveal gastric outlet obstruction. His current CT abdomen showed a fluid-filled stomach and duodenum, suggestive of gastric outlet obstruction (Figure 1). Magnetic resonance enterography (MRE) did not show obstruction, but demonstrated a 2.1 3 2.3-cm right mesenteric nodule with similar enhancement as the spleen, raising the possibility of ectopic splenic tissue, and a 0.7-cm nodule posterior to the uncinate process.Push enteroscopy revealed esophagitis and severe aphthous ulcerations in the small intestine, but no obstruction. Colonoscopy did not reveal any obstructive pathology. Video capsule enterography revealed erythematous mucosa with villous blunting and nonobstructive luminal narrowing in the duodenum through which the capsule passed easily.An 18 F-fluorodeoxyglucose positron emission tomography ( 18 FDG PET)/CT scan was performed to further evaluate the mesenteric lesion seen on MRE. It showed multiple mild to moderately FDG avid cervical lymph nodes (LN), the largest a 4-cm left supraclavicular LN. It redemonstrated the soft-tissue lesion anterior to the duodenum with mild to moderate FDG uptake and multiple

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Section: Discussionmentioning

confidence: 88%

Recurrent Gastrointestinal Pseudo-obstruction Because of Well-Differentiated Duodenal Neuroendocrine Tumor

et al. 2022

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“…SI-NETs usually have a good prognosis. if distant metastasis occurs, SI-NETs patients still have a reasonable survival rate compared with other gastrointestinal malignant tumors 15,16 . However, although the progress of SI-NETs is slow, their clinical manifestations are not common benign tumors.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Primary Tumor Resection for Metastatic Small Intestine Neuroendocrine Tumors and Survival: A Propensity Score-Matched Analysis

Yan

Yin

Han

et al. 2022

Journal of Investigative Surgery

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BackgroundAt present, it has been controversial whether primary tumor resection (PTR) can bring survival advantage to patients with metastatic small intestine neuroendocrine tumors (SI-NETs). To answer this question, we conducted a retrospective cohort study to evaluate the effect of PTR on the survival of patients with metastatic SI-NETs. MethodsInformation on SI-NENs patients from 2004 to 2015 was extracted from Surveillance, Epidemiology, and End Results (SEER) databases. Demographics, tumor characteristics, treatment, and survival were compared. Propensity score-matched (PSM) was used 1:1 in the ltered queue. Cox proportional hazard regression model was used to evaluate the correlation between surgery and treatment results. ResultsAfter PSM, there were 62 patients in the PTR group and 62 patients in the Non-PTR group. There was no signi cant difference in overall survival (OS) and cancer-speci c survival (CSS) between the two treatments. Multivariate analysis showed that there was no signi cant difference in OS and CSS between the two groups (p > 0.05). ConclusionOur study shows that OS and CSS are comparable between patients in the PTR group and those in the Non-PTR group,which suggests that PTR should be used only when necessary. Early preventive surgery should not be advocated.

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“…4 Moreover, surgical treatment can treat or avoid bowel obstruction, bleeding, and mesenteric fibrosis, among others. 4,17 Overall, RS has the potential to better morbidity and mortality rates for patients.…”

Section: Discussionmentioning

confidence: 99%

Resection Prolongs Overall Survival for Nonmetastatic Midgut Small Bowel Neuroendocrine Tumors

Bangla¹,

Wolin²,

Kim

et al. 2022

Pancreas

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ObjectivesThis study aimed to understand if resection (RS) for nonmetastatic small bowel neuroendocrine tumors (SBNETs) prolongs 5-year overall survival.MethodsPatients from National Cancer Data Base with primary histologically confirmed SBNETs from 2007 to 2016 were included. Patients younger than 18 years, with the disease in the duodenum/Meckel diverticulum or metastatic disease were excluded. We assessed 5-year survival rates using Kaplan-Meier curves and multivariate Cox proportional hazards regression after RS, nonresection surgical management (NRS), or no resection (NR). Multivariate models were adjusted with age, sex, race, insurance, Charlson-Deyo comorbidity score, academic facility, primary tumor location, clinical T, clinical N, stage, and grade.ResultsWe identified 4180 patients. On average, patients were 64 years old (standard deviation, 12 years), male (53%), and White (84%). The majority received RS (91.8%) as opposed to NRS (4.0%) or NR (4.2%). Patients who received RS versus NR had increased survival rates (84.2% vs 73.9%; univariate log-rank, P < 0.0001; multivariate hazard ratio, 0.73; 95% confidence interval, 0.53–0.99; P = 0.04). No statistical difference in survival was observed for NRS versus NR.ConclusionsTo our knowledge, this is the first national study to evaluate survival after RS for nonmetastatic SBNETs. Results suggest that RS of SBNETs may prolong 5-year survival.

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The Landmark Series: Management of Small Bowel Neuroendocrine Tumors

Cited by 19 publications

References 73 publications

Recurrent Gastrointestinal Pseudo-obstruction Because of Well-Differentiated Duodenal Neuroendocrine Tumor

Recurrent Gastrointestinal Pseudo-obstruction Because of Well-Differentiated Duodenal Neuroendocrine Tumor

Relationship between Primary Tumor Resection for Metastatic Small Intestine Neuroendocrine Tumors and Survival: A Propensity Score-Matched Analysis

Resection Prolongs Overall Survival for Nonmetastatic Midgut Small Bowel Neuroendocrine Tumors

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