Central Surgical AssociationThe palliative benefit of aggressive surgical intervention for both hepatic and mesenteric metastases from neuroendocrine tumors
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
References (25)
- et al.
The palliative role of 131I-MIBG and 111In-Octeotride therapy in patients with metastatic progressive neuroendocrine neoplasms
Surgery
(2004) - et al.
Survival and daily physical activity in patients treated for advanced midgut carcinoid tumors
Surgery
(1997) - et al.
Hepatic cytoreduction followed by a novel long-acting somatostatin analog: a paradigm for intractable neuroendocrine tumors metastatic to the liver
Surgery
(2001) - et al.
Surgical treatment of neuroendocrine metastases to the liver: a plea for resection to increase survival
J Am Coll Surg
(2003) - et al.
Hepatic neuroendocrine metastases: does intervention alter outcomes?
J Am Coll Surg
(2000) - et al.
Carcinoid tumors: analysis of prognostic factors and survival in 301 patients from a referral center
Ann Oncol
(1997) - et al.
Incidence trends and risk factors of carcinoid tumors: a nationwide epidemiologic study from Sweden
Cancer
(2001) - et al.
Updated population-based review of carcinoid tumors
Ann Surg
(2004) - et al.
Histological typing of endocrine tumours
(2000) Karnofsky memorial lecture. An odyssey in the land of small tumors
J Clin Oncol
(1987)