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Establishment and Characterization of Small Bowel Neuroendocrine Tumor Spheroids
Published on: October 14, 2019
Surgical Treatment of NEN of Small Bowel: A Retrospective Analysis
F M Watzka1, C Fottner2, M Miederer3
1Clinic of General, Visceral- and Transplantation Surgery, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
Background:
Neuroendocrine Neoplasms of the small intestine have been noticed more frequently over the past 35 years. They constitute about 25% of all NENs and 29% of all tumors of the small intestine. Due to the predominantly indolent nature and overall good prognosis, the benefit of surgical treatment is still debated.
Methods:
In a retrospective study, data of 83 surgically treated patients with neuroendocrine neoplasms of the small intestine, 48 males and 35 females with a median age of 62 years (range 25-86 years) were analyzed. Patient data were documented in the MaDoc database for neuroendocrine tumors of the University Medical Center of Mainz. IBM SPSS Statistics 20 was used for statistical analysis. Kaplan-Meier survival curves and Log-Rank tests, censoring patients at the time of last follow-up, were used to compare the overall survival depending on potential prognostic factors (stage, grade, surgical treatment).
Results:
At the time of diagnoses, the most common clinical symptoms were abdominal pain (n = 31, 37.3%), bowel obstruction (n = 11, 13.3%), bowel perforation and peritonitis (n = 3, 3.6%), gastrointestinal bleeding (n = 9, 10.8%), weight loss (n = 11, 13.3%), and carcinoid syndrome (n = 27, 32.5%). 65 patients (78.3%) had lymph node metastasis and in 58 patients (69.9%) distant metastasis were present. Segmental bowel resection (44) was the most common surgical procedure, followed by right hemi-colectomy (32) and explorative laparotomy (7). In most patients (78.9%), lymphadenectomy (systematic/selective) was performed. The 5-year survival of patients who underwent a systematic or a selective lymphadenectomy differed significantly (82.2 vs. 40.0%). The overall 3-, 5-, and 10-year survival rates were 88.2, 80.3, and 71.0%, respectively.
Conclusion:
Mesenteric lymph node metastases are almost invariably present and have significant impact on patients' prognosis. Systematic lymphadenectomy prevents complications and improves the survival. Early surgical treatment should be the goal in order to prevent complications.
Insights
Neuroendocrine neoplasms of the small intestine are increasingly diagnosed. Systematic lymphadenectomy during surgical treatment significantly improves survival rates for these patients.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Oncology
Background:
- Neuroendocrine neoplasms (NENs) of the small intestine are diagnosed more frequently, accounting for 25% of all NENs.
- Despite an indolent nature and good prognosis, the benefit of surgical intervention remains debated.
- Small intestinal tumors represent 29% of all small intestine tumors.
Purpose of the Study:
- To analyze the impact of surgical treatment and lymphadenectomy on the prognosis of patients with neuroendocrine neoplasms of the small intestine.
- To evaluate the effectiveness of systematic versus selective lymphadenectomy in improving patient survival.
- To determine the significance of mesenteric lymph node metastasis in the overall outcome.
Main Methods:
- Retrospective analysis of 83 surgically treated patients with small intestine NENs.
- Data collected from the MaDoc database at the University Medical Center of Mainz.
- Statistical analysis using IBM SPSS Statistics 20, Kaplan-Meier survival curves, and Log-Rank tests.
Main Results:
- Abdominal pain (37.3%) and carcinoid syndrome (32.5%) were the most common symptoms.
- Lymph node metastasis (78.3%) and distant metastasis (69.9%) were highly prevalent at diagnosis.
- Systematic lymphadenectomy showed significantly higher 5-year survival rates (82.2%) compared to selective lymphadenectomy (40.0%).
Conclusions:
- Mesenteric lymph node metastases are nearly universal and critically impact prognosis.
- Systematic lymphadenectomy is crucial for preventing complications and enhancing patient survival.
- Early surgical intervention is recommended to mitigate potential complications.
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