F M Watzka1, C Fottner2, M Miederer3, M M Weber2, A Schad4, H Lang1, T J Musholt5. 1. Clinic of General, Visceral- and Transplantation Surgery, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. 2. Endocrinology and Metabolic Diseases, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. 3. Clinic of Nuclear Medicine, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. 4. Institute of Pathology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. 5. Clinic of General, Visceral- and Transplantation Surgery, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. musholt@uni-mainz.de.
Abstract
BACKGROUND: Neuroendocrine Neoplasms of the small intestine have been noticed more frequently over the past 35 years. They constitute about 25% of all NENs and 29% of all tumors of the small intestine. Due to the predominantly indolent nature and overall good prognosis, the benefit of surgical treatment is still debated. METHODS: In a retrospective study, data of 83 surgically treated patients with neuroendocrine neoplasms of the small intestine, 48 males and 35 females with a median age of 62 years (range 25-86 years) were analyzed. Patient data were documented in the MaDoc database for neuroendocrine tumors of the University Medical Center of Mainz. IBM SPSS Statistics 20 was used for statistical analysis. Kaplan-Meier survival curves and Log-Rank tests, censoring patients at the time of last follow-up, were used to compare the overall survival depending on potential prognostic factors (stage, grade, surgical treatment). RESULTS: At the time of diagnoses, the most common clinical symptoms were abdominal pain (n = 31, 37.3%), bowel obstruction (n = 11, 13.3%), bowel perforation and peritonitis (n = 3, 3.6%), gastrointestinal bleeding (n = 9, 10.8%), weight loss (n = 11, 13.3%), and carcinoid syndrome (n = 27, 32.5%). 65 patients (78.3%) had lymph node metastasis and in 58 patients (69.9%) distant metastasis were present. Segmental bowel resection (44) was the most common surgical procedure, followed by right hemi-colectomy (32) and explorative laparotomy (7). In most patients (78.9%), lymphadenectomy (systematic/selective) was performed. The 5-year survival of patients who underwent a systematic or a selective lymphadenectomy differed significantly (82.2 vs. 40.0%). The overall 3-, 5-, and 10-year survival rates were 88.2, 80.3, and 71.0%, respectively. CONCLUSION: Mesenteric lymph node metastases are almost invariably present and have significant impact on patients' prognosis. Systematic lymphadenectomy prevents complications and improves the survival. Early surgical treatment should be the goal in order to prevent complications.
BACKGROUND:Neuroendocrine Neoplasms of the small intestine have been noticed more frequently over the past 35 years. They constitute about 25% of all NENs and 29% of all tumors of the small intestine. Due to the predominantly indolent nature and overall good prognosis, the benefit of surgical treatment is still debated. METHODS: In a retrospective study, data of 83 surgically treated patients with neuroendocrine neoplasms of the small intestine, 48 males and 35 females with a median age of 62 years (range 25-86 years) were analyzed. Patient data were documented in the MaDoc database for neuroendocrine tumors of the University Medical Center of Mainz. IBM SPSS Statistics 20 was used for statistical analysis. Kaplan-Meier survival curves and Log-Rank tests, censoring patients at the time of last follow-up, were used to compare the overall survival depending on potential prognostic factors (stage, grade, surgical treatment). RESULTS: At the time of diagnoses, the most common clinical symptoms were abdominal pain (n = 31, 37.3%), bowel obstruction (n = 11, 13.3%), bowel perforation and peritonitis (n = 3, 3.6%), gastrointestinal bleeding (n = 9, 10.8%), weight loss (n = 11, 13.3%), and carcinoid syndrome (n = 27, 32.5%). 65 patients (78.3%) had lymph node metastasis and in 58 patients (69.9%) distant metastasis were present. Segmental bowel resection (44) was the most common surgical procedure, followed by right hemi-colectomy (32) and explorative laparotomy (7). In most patients (78.9%), lymphadenectomy (systematic/selective) was performed. The 5-year survival of patients who underwent a systematic or a selective lymphadenectomy differed significantly (82.2 vs. 40.0%). The overall 3-, 5-, and 10-year survival rates were 88.2, 80.3, and 71.0%, respectively. CONCLUSION: Mesenteric lymph node metastases are almost invariably present and have significant impact on patients' prognosis. Systematic lymphadenectomy prevents complications and improves the survival. Early surgical treatment should be the goal in order to prevent complications.
Authors: Christine S Landry; Heather Y Lin; Alexandria Phan; Chusilp Charnsangavej; Eddie K Abdalla; Thomas Aloia; J Nicolas Vauthey; Matthew H G Katz; James C Yao; Jason B Fleming Journal: World J Surg Date: 2013-07 Impact factor: 3.352
Authors: H Ahlman; B Wängberg; S Jansson; O Stenqvist; K Geterud; U Tylén; K Caidahl; T Scherstén; L E Tisell Journal: Digestion Date: 1991 Impact factor: 3.216
Authors: Karl Y Bilimoria; David J Bentrem; Jeffrey D Wayne; Clifford Y Ko; Charles L Bennett; Mark S Talamonti Journal: Ann Surg Date: 2009-01 Impact factor: 12.969
Authors: Maximilian Evers; Anja Rinke; Johannes Rütz; Annette Ramaswamy; Elisabeth Maurer; Detlef K Bartsch Journal: World J Surg Date: 2021-01-08 Impact factor: 3.352
Authors: Benjamin M Motz; Patrick D Lorimer; Danielle Boselli; Joshua S Hill; Jonathan C Salo Journal: J Gastrointest Surg Date: 2017-08-17 Impact factor: 3.452
Authors: James R Howe; Kenneth Cardona; Douglas L Fraker; Electron Kebebew; Brian R Untch; Yi-Zarn Wang; Calvin H Law; Eric H Liu; Michelle K Kim; Yusuf Menda; Brian G Morse; Emily K Bergsland; Jonathan R Strosberg; Eric K Nakakura; Rodney F Pommier Journal: Pancreas Date: 2017-07 Impact factor: 3.327
Authors: Mohammad Y Zaidi; Alexandra G Lopez-Aguiar; Mary Dillhoff; Eliza Beal; George Poultsides; Eleftherios Makris; Flavio Rocha; Angelena Crown; Kamran Idrees; Paula Marincola Smith; Hari Nathan; Megan Beems; Daniel Abbott; James R Barrett; Ryan C Fields; Jesse Davidson; Kenneth Cardona; Shishir K Maithel Journal: JAMA Surg Date: 2019-02-01 Impact factor: 14.766
Authors: Chintan P Shah; Lazarus K Mramba; Rohit Bishnoi; Athira Unnikrishnan; Jennifer M Duff; Sreenivasa R Chandana Journal: J Gastrointest Oncol Date: 2019-10