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Principles of Surgical Management of Small Intestinal NET.

Arnaud Pasquer1,2, Thomas Walter2,3,4, Laurent Milot2,3,5

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Surgical resection of small-intestinal neuroendocrine tumors (siNETs) is crucial for localized disease. The primary challenge is achieving oncological clearance while preventing short small bowel syndrome.

Keywords:
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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Oncology

Background:

  • Small-intestinal neuroendocrine tumors (siNETs) represent 25% of gastroenteropancreatic neuroendocrine tumors.
  • Multiple siNETs commonly occur in a localized segment of the ileum, near the ileocecal valve.
  • Current guidelines recommend radical surgical resection with lymphadenectomy for all localized siNETs.

Purpose of the Study:

  • To outline the current surgical management strategies for small-intestinal neuroendocrine tumors (siNETs).
  • To emphasize the importance of preoperative evaluation and surgical techniques to optimize patient outcomes.
  • To discuss the challenges and evolving nature of siNET surgery.

Main Methods:

  • Comprehensive preoperative assessment including medical history, carcinoid syndrome symptoms, CT, PET/CT, and hepatic MRI.
  • Detailed morphological evaluation and biochemical assessment (24-hour urinary 5-hydroxyindoleacetic acid).
  • Surgical approach favoring open laparotomy for thorough exploration and palpation, with extensive lymphadenectomy and prophylactic cholecystectomy.

Main Results:

  • The limiting factor in resection is preserving adequate jejunal length to avoid short small bowel syndrome.
  • Open laparotomy is considered the gold standard for surgical exploration and palpation of siNETs.
  • Extensive lymphadenectomy and prophylactic cholecystectomy are recommended surgical components.

Conclusions:

  • Surgical management of siNETs is continuously evolving, with a focus on balancing oncological outcomes and functional preservation.
  • The oncological benefits of resection are increasingly recognized, leading to updated recommendations.
  • Establishing reproducible quality criteria for siNET procedures is essential for future advancements.