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Neuroendokrine Neoplasien des gastroenteropankreatischen Systems

Chirurgische Therapie

Gastroenteropancreatic neuroendocrine neoplasms

Surgical treatment

Zusammenfassung

Hintergrund

Gastroenteropankreatische neuroendokrine Neoplasien (GEP-NEN) stellen eine heterogene Tumorgruppe dar, welche sich hinsichtlich ihrer Prognose und Therapie von gewöhnlichen Adenokarzinomen des Gastrointestinaltrakts unterscheidet. Neben der chirurgischen Therapie stehen Biotherapie, Chemotherapie, Radiopeptidtherapie oder lokal ablative Verfahren zur Verfügung.

Ziel der Arbeit

Die Übersichtsarbeit soll aktuelle chirurgische Behandlungsstrategien von GEP-NEN darstellen.

Material und Methoden

Es wurden Publikationen und geltende Leitlinien zur Behandlung neuroendokriner Neoplasien ausgewertet.

Ergebnisse

GEP-NEN stellen aufgrund ihres variablen biologischen Verhaltens, der ggf. bestehenden hormonellen Aktivität und nicht selten assoziierter genetischer Prädispositionen komplexe Erkrankungen dar. Die vollständige Erfassung der klinischen Erscheinungsbilder ist Voraussetzung für ein differenziertes therapeutisches Vorgehen. Das therapeutische Spektrum umfasst neben der chirurgischen Resektion Biotherapie, Chemotherapie, Radiopeptidtherapie und lokal ablative Verfahren. Die chirurgische Therapie ist für die Behandlung neuroendokriner Neoplasien von zentraler Bedeutung. Aufgrund bisher unzureichender Evidenz zu Indikation, Zeitpunkt und notwendigem Resektionsausmaß chirurgischer Therapiestrategien fehlen jedoch in vielen Bereichen detaillierte Angaben in den geltenden Leitlinien.

Diskussion

Das chirurgische Vorgehen wird weiterhin in hohem Maße von zentrumsspezifischen Erfahrungen bestimmt. Die Beurteilung der präoperativen Befunde und die Festlegung des Vorgehens sollten in einem spezialisierten interdisziplinären Tumorboard erfolgen.

Abstract

Background

Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) constitute a heterogeneous group of tumors. Prognosis and therapy differ significantly from adenocarcinomas of the gastrointestinal tract. Apart from surgery biotherapy, chemotherapy, radiopeptide therapy, and local ablation are available treatment options.

Objectives

The review describes the current surgical treatment strategies for GEP-NENs.

Materials and methods

Publications and established guidelines for the treatment of neuroendocrine neoplasms were evaluated.

Results

Because of the variable biological behavior, the possible hormone activity, and the frequently associated genetic predisposition, GEP-NENs present complex clinical pictures. The differentiated therapy is based on the comprehensive evaluation of the clinical situation. Apart from surgical resection the therapeutic spectrum encompasses biotherapy, chemotherapy, peptide receptor radionuclide therapy (PRRT), and local ablative methods. Surgical treatment is the only curative option and therefore of central importance. However, owing to the limited evidence referring to indication, optimal time, and the necessary extent of resection, detailed information is not outlined in many areas in the current guidelines.

Conclusions

The surgical strategy is still predominantly guided by center-specific experience. The assessment of preoperative findings and the determination of the optimal strategy should be discussed on specialized interdisciplinary boards.

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Correspondence to Prof. Dr. T. J. Musholt.

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Interessenkonflikt

T. J. Musholt und F. M. Watzka geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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R. Schmid, München

B. Wiedenmann, Berlin

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Musholt, T.J., Watzka, F.M. Neuroendokrine Neoplasien des gastroenteropankreatischen Systems. Gastroenterologe 10, 410–417 (2015). https://doi.org/10.1007/s11377-015-0003-2

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Schlüsselwörter

  • Neoplasie
  • Neuroendokriner Tumor
  • Gastrointestinaltrakt
  • Adenokarzinom
  • Therapie

Keywords

  • Neoplasms
  • Neuroendocrine tumor
  • Gastrointestinal tract
  • Adenocarcinoma
  • Therapy