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ASO Practice Guidelines Series: Surgical Management of Gastrointestinal (Midgut) Neuroendocrine Neoplasms

  • Gastrointestinal Oncology
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Abstract

Gastrointestinal midgut neuroendocrine neoplasms (NENs) are a heterogeneous group of uncommon malignancies. For well-differentiated NENs, known as neuroendocrine tumors (NETs), surgery is a cornerstone of management in localized and metastatic disease. Because of heterogeneous tumor behaviour, association with endocrine syndrome, and prognosis, the management of NETs must be individualized to all these factors in addition to the primary site. With the fast pace of advancement in the field, both for therapies and understanding of tumoral etiology and behaviour, it is important for surgical oncologists to remain updated on guidelines recommendations and suggested treatment pathways. Those guidelines provide important guidance for management of NETs but are largely based on expert opinions and interpretation of retrospective evidence. This article reviews highlights of most recent practice guidelines for midgut (gastric, duodenal, small intestinal, and appendiceal) NETs.

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Fig. 1
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Adapted from Öhrvall U et al. World J Surg. 2014;24(11):1402-8.

Fig. 4

Adapted from ENETS guidance document, Kaltsas G et al. J Neuroendocrinology. 2023;EPublication.

Fig. 5

Adapted from NANETS expert consensus guideline, Howe JR et al. Pancreas 2017;46(6):715–31.

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Authors and Affiliations

  1. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Julie Hallet MD, MSc

  2. Susan Leslie Clinic for Neuroendocrine Tumors, Odette Cancer Centre – Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Julie Hallet MD, MSc

  3. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Callisia N. Clarke MD, MS

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Hallet, J., Clarke, C.N. ASO Practice Guidelines Series: Surgical Management of Gastrointestinal (Midgut) Neuroendocrine Neoplasms. Ann Surg Oncol 31, 1704–1713 (2024). https://doi.org/10.1245/s10434-023-14802-8

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