Update on Surgical Management of Small Bowel Neuroendocrine Tumors

Abstract

Abstract. The widespread use of endoscopy and imaging in combination with

Surgery and Perioperative Management in Small Intestinal Neuroendocrine Tumors

“…Surgical treatment is a cornerstone of SI-NET multimodal management and may be curative when a complete R0 resection is obtained. However, a R0 resection is feasible in only 20% of cases due to the usual advanced stage at diagnosis [ 57 ].…”

“…Short bowel syndrome should be avoided. The length of the resected small bowel is not correlated to the amount of resected lymph nodes [ 29 , 57 ]. The surgical approach should not be a ‘pizza pie’ approach—large intestinal plus small mesentery resection—and the inverse approach should become the standard ( Figure 3 ) [ 25 ].…”

“…Exploration is the first surgical step, as up to 60–70% of the disease is missed on preoperative imaging [ 17 , 57 , 58 ]. The surgeon must palpate the entire small bowel and search for carcinomatosis and ovarian and liver metastases.…”

“…Laparotomy is traditionally the approach of choice, because it allows an optimal exploration of the entire abdominal cavity including small bowel palpation and vascular control at the origin of the superior mesenteric vessels [ 68 ]. For these reasons, a purely laparoscopic approach for curative surgery in SI-NETs remains controversial [ 15 , 57 , 58 ]. Hence, NANETS and ENETS guidelines suggest a hybrid procedure combining laparoscopy and manual palpation of the entire small bowel after its exteriorization by a hand port ( Figure 6 ), as proposed by Wang et al [ 15 , 68 , 97 ].…”

“…Hence, NANETS and ENETS guidelines suggest a hybrid procedure combining laparoscopy and manual palpation of the entire small bowel after its exteriorization by a hand port ( Figure 6 ), as proposed by Wang et al [ 15 , 68 , 97 ]. Yet, such a procedure should not be considered if an incomplete nodal resection is predictable large MLNM or MLNM around the superior mesenteric axis [ 57 ]. We also recommend the exclusion of patients with retropancreatic MLNM, carcinomatosis, and/or abdominal obesity which may preclude intestinal exteriorization by the hand port.…”