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Morbidity and Outcomes of Primary Tumor Management in Patients with Widely Metastatic Well-Differentiated Small Bowel Neuroendocrine Tumors

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The benefit of primary tumor resection in distant metastatic small bowel neuroendocrine tumors (SBNETs) is controversial, with treatment-based morbidity not well-defined. We aimed to determine the impact of primary tumor resection on development of disease-specific complications in patients with metastatic well-differentiated SBNETs.

Patients and Methods

A retrospective analysis was performed of patients diagnosed with metastatic well-differentiated jejunal/ileal SBNETs at a single tertiary care cancer center from 1980 to 2016. Outcomes were compared on the basis of treatment selected at diagnosis between patients who underwent initial medical treatment or primary tumor resection.

Results

Among 180 patients, 71 underwent medical management and 109 primary tumor resection. Median follow-up was 116 months. Median event-free survival did not differ between treatment approaches (log-rank p = 0.2). In patients medically managed first, 16/71 (23%) required surgery due to obstruction, perforation, or bleeding. These same complications led to resection at presentation in 31/109 (28%) surgically treated patients. Development of an obstruction from the primary tumor was not associated with disease progression/recurrence (HR 1.14, 95% CI 0.75–1.75) with all patients recovering postoperatively. Ongoing tumor progression requiring secondary laparotomy was associated with worse mortality (HR 7.51, 95% CI 3.3–16.9; p < 0.001) and occurred in 20/109 (18%) primary tumor resection and 7/16 (44%) initially medically treated patients.

Conclusions

Rates of event-free survival among patients with metastatic SBNETs do not differ on the basis of primary tumor management. The development of an obstruction from the primary tumor was not associated with worse outcomes with all patients salvaged. Regardless of initial treatment selected, patients with metastatic SBNET should be closely followed for early signs of primary tumor complications.

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Funding

This project was supported in part by an NCI Cancer Center Support Grant (P30 CA008748) supporting the institution’s core resources and by the National Institutes of Health (T32CA009685).

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Aradhya Nigam MD, Janet W. Y. Li MD, Kelvin Memeh MD & Brian R. Untch MD

  2. Department of Epidemiology and Statistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Megan Fiasconaro MS, BS, Sabrina Lin MS, BS & Marinela Capanu PhD

  3. Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA

    David A. Kleiman MD

  4. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Nitya Raj MD & Diane L. Reidy-Lagunes MD

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  1. Aradhya Nigam MD
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  2. Janet W. Y. Li MD
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  3. Megan Fiasconaro MS, BS
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Correspondence to Brian R. Untch MD.

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Nigam, A., Li, J.W.Y., Fiasconaro, M. et al. Morbidity and Outcomes of Primary Tumor Management in Patients with Widely Metastatic Well-Differentiated Small Bowel Neuroendocrine Tumors. Ann Surg Oncol 31, 2337–2348 (2024). https://doi.org/10.1245/s10434-023-14637-3

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