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Multifocality in Small Bowel Neuroendocrine Tumors

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Neuroendocrine tumors (NETs) account for 30% of small bowel (SB) neoplasms. The objectives of this study were to evaluate the incidence of multifocality in primary small bowel neuroendocrine tumors (SBNETs) and to examine the associated outcomes.

Methods

Patients with multifocal SBNET were compared to those with a solitary lesion. Only patients who underwent diagnostic workup and surgical intervention at our institution were included in this study. The primary aim of our study was surgical outcomes and mortality and recurrence. The second aim of our study was to evaluate the utility of double-balloon enteroscopy (DBE) and capsule endoscopy.

Results

Of 178 patients with SBNETs during the study period, 85 met inclusion criteria. The mean age was 61.0 ± 12.6 years and 44.7% were male. The ileum was the primary tumor site for 66 patients (77.7%). Of DBE patients, 28 (62.2%) had additional lesions identified, of which 23 (82.1%) had NET confirmed on pathology. Average tumor size was 1.8 cm and most were well differentiated (89.9%), with Ki-67 of ≥ 2% (65.8%); 74.4% had nodal metastases and 51% of patients had stage IV disease. Forty-six patients (54.1%) had multifocal disease, of whom 37 (80.5%) had an ileal primary. No differences in survival or recurrence were seen for multifocal versus solitary disease.

Conclusions

SBNETs have a high incidence of multifocality. DBE can be used in the preoperative assessment to detect multifocal NET. Multifocality has no impact on survival or recurrence outcomes.

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Acknowledgements

The authors would like to acknowledge the work of Neel Mann, MD, who performed many of the double-balloon enteroscopies as part of the workup of these patients.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology and Hepatobiliary Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Alexandra Gangi, Emily Siegel, Galinos Barmparas, Nicholas N. Nissen & Farin Amersi

  2. Center for Digestive Diseases and Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Simon Lo & Laith H. Jamil

  3. Department of Internal Medicine, Division of Hematology and Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Andrew Hendifar

  4. Montefiore Einstein Center for Cancer Care, Bronx, NY, USA

    Edward M. Wolin

  5. Samuel Oschin Comprehensive Cancer Institute, 8700 Beverly Blvd, #AC-1046A, Los Angeles, CA, 90048, USA

    Farin Amersi

Authors
  1. Alexandra Gangi
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  2. Emily Siegel
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  3. Galinos Barmparas
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  4. Simon Lo
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  5. Laith H. Jamil
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  6. Andrew Hendifar
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  7. Nicholas N. Nissen
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  8. Edward M. Wolin
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  9. Farin Amersi
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Contributions

All authors listed in the manuscript (A. Gangi., E. Siegel, G. Barmparas, S. Lo, L. Jamil, A. Hendifar, N. Nissen, E. Wolin, F. Amersi) have all made substantial contributions to the design of this study, have all participated in drafting and revising the manuscript, and have all approved the final version to be published. In addition, all the authors agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Farin Amersi.

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The authors declare that they have no conflict of interest.

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Gangi, A., Siegel, E., Barmparas, G. et al. Multifocality in Small Bowel Neuroendocrine Tumors. J Gastrointest Surg 22, 303–309 (2018). https://doi.org/10.1007/s11605-017-3586-8

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  • DOI: https://doi.org/10.1007/s11605-017-3586-8

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