How to Manage Small Intestine (Jejunal and Ileal) Neuroendocrine Neoplasms Presenting with Liver Metastases?

Abstract

Purpose of Review Small intestinal neuroendocrine neoplasms (siNENs) are slowly growing tumours with a low malignant potential. However, more than half of the patients present with distant metastases (stage IV) and nearly all with locoregional lymph node (LN) metastases at the time of surgery. The value of locoregional treatment is discussed controversially. Recent Findings In stage I to III disease, locoregional surgery was currently shown to be curative prolonging survival. In stage IV disease, surgery may prolong survival in selected patients with the chance to cure locoregional disease besides radical/debulking liver surgery. It may improve the quality of life and may prevent severe local complications resulting in a state of chronic malnutrition and severe intestinal ischaemia or bowel obstruction. Summary Locoregional tumour resection offers the opportunity to be curative or to focus therapeutically on liver metastasis, facilitating various other therapeutic modalities. Risks and benefits of the surgical intervention need to be balanced individually.

Practical considerations when providing palliative care to patients with neuroendocrine tumors in the context of routine disease management or hospice care

“…These symptoms may be due to various causes, including the release of biogenic amines (5-HIAA) (Mota et al, 2016, Oberg, 2012. In addition to the management of hormone excess with SSA (or other medications for other functional NETs), first line antidepressants such as SSRIs appear safe in NET patients with and without carcinoid syndrome (Nobels et al, 2016, Hemminki and Li, 2001, Isenberg-Grzeda et al, 2018.…”

“…For many patients suffering from NETs, surgical intervention is by definition, palliative (i.e., to improve symptoms and quality of life, but not necessarily effect a cure). Although surgical eradication of disease is possible, many patients present with stage IV disease and as such, surgical cure is not possible (Niederle et al, 2021, Goretzki et al, 2018, Koea and Commonwealth Neuroendocrine Tumour Research Collaborative Surgical, 2021. Depending on the health and wellbeing of the patient at the time of presentation, many patients with unresectable disease are suitable for non-curative surgery to treat symptoms.…”

Influence of Lymphatic, Microvascular and Perineural Invasion on Oncological Outcome in Patients with Neuroendocrine Tumors of the Small Intestine

“…Despite the fact that most tumors are diagnosed in locally advanced or metastatic stages, patients suffering from this disease still face a relatively good prognosis. While complete tumor resection remains the only curative therapy, it is largely established that cytoreductive therapy in the sense of debulking surgery is beneficial for patients where complete resection cannot be achieved [2,3]. For the histopathological work-up of resected specimens, the determination of lymphatic (LI), vascular (VI) and perineural sheath (PnI) invasion is recommended in addition to the indication of proliferation-based grading, histopathological classification and tumor and lymph node stage [4,5].…”