Abstract
While small bowel resection is well established as standard of care for curative-intent management of localized and loco-regional small bowel neuroendocrine tumors (SB-NETs), resection of the primary tumor in the setting of metastatic disease is debated. This review addresses the role of primary tumor resection for stage IV well-differentiated grade 1 and 2 SB-NETs. While survival benefits have been reported for primary tumor resection in the setting of metastatic disease, these studies are limited by selection bias and thus controversial. The main clinical benefits of primary tumor resection for stage IV disease involve the prevention of potentially debilitating complications associated with mesenteric fibrosis, including intestinal obstruction, mesenteric ischemia and angina, venous congestion, malabsorption, and malnutrition. Patients with metastases undergoing initial resection of the primary SB-NETs appear to have fewer episodes of care and re-intervention for loco-regional complications than those who do not undergo resection. As recommended by the NANETS and ENETS guidelines, resection of the primary tumor for stage IV SB-NETs should be strongly considered to avoid future loco-regional complications and potentially to improve survival. All patients with stage IV SB-NETs should be assessed by a surgeon experienced in the management of NETs to consider surgical therapies, including resection of the primary tumor despite metastatic disease.
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Acknowledgements
The CommNETS Surgical Section includes Dr Julie Hallet and Dr Calvin Law, Susan Leslie Clinic for Neuroendocrine Tumors, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Dr Janice Pasieka, Tom Baker Cancer Centre, Calgary, Alberta, Canada; Dr Jonathan Koea, North Shore Hospital, Auckland, New Zealand; Dr. Win Meyer-Rochow, Waikato Hospital, Hamilton, New Zealand.
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The CommNETS Collaboration is supported by unconditional educational Grant from Ipsen Canada and an unconditional sponsorship grant from Ipsen Australia. JH and CL have received speaking honoraria from Ipsen Biopharmaceuticals Canada, Novartis Oncology, and Advanced Accelerated Applications.
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This article is a contribution to the Symposium entitled, “Surgical Dilemmas and Challenges for the Operating Surgeon in the Management of Small Bowel Neuroendocrine Tumours: A CommNETs Symposium”.
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Hallet, J., Law, C. & the Commonwealth Neuroendocrine Tumours Research Collaborative (CommNETs) Surgical Section. Role of Primary Tumor Resection for Metastatic Small Bowel Neuroendocrine Tumors. World J Surg 45, 213–218 (2021). https://doi.org/10.1007/s00268-020-05727-4
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DOI: https://doi.org/10.1007/s00268-020-05727-4