Principles of Surgical Management of Small Intestinal NET

Introduction: Small-intestinal neuroendocrine tumors (siNETs) account for 25% of gastroenteropancreatic NETs. Multiple siNETs appear to develop in a limited segment of the small bowel (SB), 89% of them being located in the ileum, most often within 100 cm of the ileocecal valve (ICV). According to th...

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Autores principales:	Arnaud Pasquer, Thomas Walter, Laurent Milot, Valérie Hervieu, Gilles Poncet
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	small bowel neuroendocrine tumors surgery lymphadenectomy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/49228723bf2d434198b869893cb05d6b
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spelling	oai:doaj.org-article:49228723bf2d434198b869893cb05d6b2021-11-11T15:33:38ZPrinciples of Surgical Management of Small Intestinal NET10.3390/cancers132154732072-6694https://doaj.org/article/49228723bf2d434198b869893cb05d6b2021-10-01T00:00:00Zhttps://www.mdpi.com/2072-6694/13/21/5473https://doaj.org/toc/2072-6694Introduction: Small-intestinal neuroendocrine tumors (siNETs) account for 25% of gastroenteropancreatic NETs. Multiple siNETs appear to develop in a limited segment of the small bowel (SB), 89% of them being located in the ileum, most often within 100 cm of the ileocecal valve (ICV). According to the European Neuroendocrine Tumor Society (ENETS) and the American Joint Committee on Cancer (AJCC), all localized siNETs should be considered for radical surgical resection with adequate lymphadenectomy irrespective of the absence of lymphadenopathy or mesenteric involvement. Surgical management of siNETs: The preoperative workout should include a precise evaluation of past medical and surgical history, focusing on the symptoms of carcinoid syndrome (flush, diarrhea, and cardiac failure). Morphological evaluation should include a CT scan including a thin-slice arterial CT, a PET/CT with 68 Ga, and a hepatic MRI in cases of suspected metastasis. Levels of 24 h urinary 5-hydroxyindoleacetic acid are needed. Regarding surgery, the limiting component is the number of free jejunal branches allowing a resection without risk of short small bowel syndrome. The laparoscopic approach has been poorly studied, and open laparotomy remains the gold standard to explore the abdominal cavity and entirely palpate the small bowel through bidigital palpation and compression. An extensive lymphadenectomy is required. A prophylactic cholecystectomy should be performed. In case of emergency surgery, current recommendations are not definitive. However, there is expert agreement that it is not reasonable to initiate resection of the mesenteric mass without comprehensive workup and mapping. Conclusion: The surgery of siNETs is in constant evolution. The challenge lies in the ability to propose a resection without imposing short small bowel syndrome on the patients. The oncological benefits supported in the literature led to recent changes in the recommendations of academic societies. The next steps remain the dissemination of reproducible quality criteria to perform these procedures.Arnaud PasquerThomas WalterLaurent MilotValérie HervieuGilles PoncetMDPI AGarticlesmall bowel neuroendocrine tumorssurgerylymphadenectomyNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCancers, Vol 13, Iss 5473, p 5473 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	small bowel neuroendocrine tumors surgery lymphadenectomy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	small bowel neuroendocrine tumors surgery lymphadenectomy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Arnaud Pasquer Thomas Walter Laurent Milot Valérie Hervieu Gilles Poncet Principles of Surgical Management of Small Intestinal NET
description	Introduction: Small-intestinal neuroendocrine tumors (siNETs) account for 25% of gastroenteropancreatic NETs. Multiple siNETs appear to develop in a limited segment of the small bowel (SB), 89% of them being located in the ileum, most often within 100 cm of the ileocecal valve (ICV). According to the European Neuroendocrine Tumor Society (ENETS) and the American Joint Committee on Cancer (AJCC), all localized siNETs should be considered for radical surgical resection with adequate lymphadenectomy irrespective of the absence of lymphadenopathy or mesenteric involvement. Surgical management of siNETs: The preoperative workout should include a precise evaluation of past medical and surgical history, focusing on the symptoms of carcinoid syndrome (flush, diarrhea, and cardiac failure). Morphological evaluation should include a CT scan including a thin-slice arterial CT, a PET/CT with 68 Ga, and a hepatic MRI in cases of suspected metastasis. Levels of 24 h urinary 5-hydroxyindoleacetic acid are needed. Regarding surgery, the limiting component is the number of free jejunal branches allowing a resection without risk of short small bowel syndrome. The laparoscopic approach has been poorly studied, and open laparotomy remains the gold standard to explore the abdominal cavity and entirely palpate the small bowel through bidigital palpation and compression. An extensive lymphadenectomy is required. A prophylactic cholecystectomy should be performed. In case of emergency surgery, current recommendations are not definitive. However, there is expert agreement that it is not reasonable to initiate resection of the mesenteric mass without comprehensive workup and mapping. Conclusion: The surgery of siNETs is in constant evolution. The challenge lies in the ability to propose a resection without imposing short small bowel syndrome on the patients. The oncological benefits supported in the literature led to recent changes in the recommendations of academic societies. The next steps remain the dissemination of reproducible quality criteria to perform these procedures.
format	article
author	Arnaud Pasquer Thomas Walter Laurent Milot Valérie Hervieu Gilles Poncet
author_facet	Arnaud Pasquer Thomas Walter Laurent Milot Valérie Hervieu Gilles Poncet
author_sort	Arnaud Pasquer
title	Principles of Surgical Management of Small Intestinal NET
title_short	Principles of Surgical Management of Small Intestinal NET
title_full	Principles of Surgical Management of Small Intestinal NET
title_fullStr	Principles of Surgical Management of Small Intestinal NET
title_full_unstemmed	Principles of Surgical Management of Small Intestinal NET
title_sort	principles of surgical management of small intestinal net
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/49228723bf2d434198b869893cb05d6b
work_keys_str_mv	AT arnaudpasquer principlesofsurgicalmanagementofsmallintestinalnet AT thomaswalter principlesofsurgicalmanagementofsmallintestinalnet AT laurentmilot principlesofsurgicalmanagementofsmallintestinalnet AT valeriehervieu principlesofsurgicalmanagementofsmallintestinalnet AT gillesponcet principlesofsurgicalmanagementofsmallintestinalnet
_version_	1718435175547797504

Principles of Surgical Management of Small Intestinal NET

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