Elsevier

Surgery

Volume 144, Issue 4, October 2008, Pages 645-653
Surgery

Central Surgical Association
The palliative benefit of aggressive surgical intervention for both hepatic and mesenteric metastases from neuroendocrine tumors

https://doi.org/10.1016/j.surg.2008.06.008Get rights and content

Background

Metastatic neuroendocrine tumors (NETs) can present with complications of gastrointestinal tract obstruction or ischemia and carcinoid syndrome (CS). The purpose of this study was to assess whether aggressive surgical intervention of metastatic NETs provides effective palliation from these symptoms.

Methods

Sixty-six patients with metastatic gastrointestinal tract NETs that presented with either CS and/or obstructive symptoms were retrospectively reviewed. All patients were managed according to a standardized protocol that involved initial surgical resection of regional and/or hepatic disease followed by appropriate medical therapy.

Results

Symptoms of obstruction or ischemia were present in 24 patients (36%) and CS in 56 (85%). All patients with obstructive symptoms undergoing operative therapy had complete symptomatic relief. Hepatic cytoreduction was performed in 30 (45%). Overall symptoms of CS improved in 42 patients (75%); 86% of patients that underwent hepatic cytoreduction and 64% of those receiving medical therapy alone (P = .064). Postoperative morbidity was 22% with no mortality. Mean follow-up was 47 months (range, 6−156). Overall 5-year survival rate was 74%.

Conclusions

Surgical resection is highly effective in relieving symptoms of intestinal obstruction and ischemia. Hepatic cytoreduction seems to enhance the ability to control the symptoms of carcinoid syndrome. A surgically aggressive approach in patients with metastatic NETs provides effective palliation in carefully selected patients.

Section snippets

Patients and methods

Patients with gastrointestinal NETs with nodal and/or hepatic metastases presenting with symptoms of gastrointestinal obstruction and/or ischemia or with symptoms of carcinoid syndrome who underwent surgical intervention between 1995 and 2007 were examined retrospectively. Symptoms were defined as being consistent with gastrointestinal obstruction and/or ischemia where a history of abdominal pain, nausea, vomiting, audible bowel sounds, or obstipation was present (Table I). Symptoms of

Patient population

From our NET clinic database of over 350 patients, 184 patients were identified as potential candidates for this study. Sixty-six patients with gastrointestinal NET met the inclusion criteria, presenting with symptoms of either gastrointestinal obstruction and/or ischemia or with carcinoid syndrome. The mean age of the study patients was 60 years (range, 17 to 83), and the gender distribution was 41 males and 25 females. Symptoms of carcinoid syndrome were evident in 56 patients (85%) at the

Discussion

The management of metastatic NETs is complex, and several therapeutic modalities exist for the treatment of complications of locoregional disease and for the control of disseminated metastases and the resulting endocrinopathy. Operative therapy is rarely curative in the setting of metastatic disease, but it has an important role in achieving effective palliation in selected patients. Symptoms of intestinal obstruction or ischemia occur in 32% to 60% of patients with intestinal NETs, and

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