Operative resection of primary carcinoid neoplasms in patients with liver metastases yields significantly better survival

Givi, Babak; Pommier, Su Ellen J.; Thompson, Alivia K.; Diggs, Brian S.; Pommier, Rodney F.

doi:10.1016/j.surg.2006.07.033

Cited by 175 publications

(120 citation statements)

References 15 publications

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“…Secondly, in patients with unresectable liver metastases it has the palliative aim of avoiding local complications, such as obstruction and bleeding. Finally, even when curative resection of liver metastases is no longer a possibility, the resection of primary tumors (mesenteric lymph node metastases included) may still provide substantial survival benefit [4,5,[14][15][16]. However, strong evidences supporting this approach are lacking and the ENETS Consensus Guidelines suggest caution: an interdisciplinary team should evaluate patients that fit for surgery with unresectable liver metastases [17].…”

Section: Discussionmentioning

confidence: 99%

The Role of Wireless Capsule Endoscopy (WCE) in the Detection of Occult Primary Neuroendocrine Tumors

Furnari

Buda²,

Delconte

et al. 2017

JGLD

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Background & Aims: Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms with unclear etiology that may show functioning or non-functioning features. Primary tumor localization often requires integrated imaging. The European Neuroendocrine Tumors Society (ENETS) guidelines proposed wireless-capsule endoscopy (WCE) as a possible diagnostic tool for NETs, if intestinal origin is suspected. However, its impact on therapeutic management is debated. We aimed to evaluate the yield of WCE in detecting intestinal primary tumor in patients showing liver NET metastases when first-line investigations are inconclusive.Method: Twenty-four patients with histological diagnosis of metastatic NET from liver biopsy and no evidence of primary lesions at first-line investigations were prospectively studied in an ENETS-certified tertiary care center. Wireless-capsule endoscopy was requested before explorative laparotomy and intra-operative ultrasound. The diagnostic yield of WCE was compared to the surgical exploration.Results: Sixteen subjects underwent surgery; 11/16 had positive WCE identifying 16 bulging lesions. Mini-laparotomy found 13 NETs in 11/16 patients (9 small bowel, 3 pancreas, 1 bile ducts). Agreement between WCE and laparotomy was recorded in 9 patients (Sensitivity=75%; Specificity=37.5%; PPV=55%; NPV=60%). Correspondence assessed per-lesions produced similar results (Sensitivity=70%; Specificity=25%; PPV=44%; NPV=50%). No capsule retentions were recorded.Conclusions: Wireless-capsule endoscopy is not indicated as second-line investigation for patients with gastro-entero-pancreatic NETs. In the setting of a referral center, it might provide additional information when conventional investigations are inconclusive about the primary site.Abbreviations: DBE: double balloon enteroscopy; GEP-NET: gastro-entero-pancreatic neuroendocrine tumor; GI: gastrointestinal; ENETS: European Neuroendocrine Tumor Society; NET: neuroendocrine tumor; SSRS: somatostatin receptor scintigraphy; WCE: wireless capsule endoscopy.

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Section: Discussionmentioning

confidence: 99%

The Role of Wireless Capsule Endoscopy (WCE) in the Detection of Occult Primary Neuroendocrine Tumors

Furnari

Buda²,

Delconte

et al. 2017

JGLD

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“…18 Resection of the primary tumor may also result in better progression-free survival and overall survival even in patients with metastatic disease. 19 Despite the availability of various imaging modalities, the primary tumor is not identified in 20-50% of gastroenteropancreatic neuroendocrine tumors. 1 Histological evaluation of a liver biopsy containing metastatic neuroendocrine tumor provides another possible method for identification of the primary site of origin of the tumor.…”

Section: Discussionmentioning

confidence: 99%

Value of Islet 1 and PAX8 in identifying metastatic neuroendocrine tumors of pancreatic origin

et al. 2012

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Neuroendocrine tumors can present as liver metastases before discovery of the primary tumor. Islet 1 and PAX8 have recently been proposed as markers for neuroendocrine tumors of pancreatic origin. In this study, we compared the utility of Islet 1 and PAX8 in distinguishing pancreatic neuroendocrine tumors from neuroendocrine tumors of other sites and determined the usefulness of an immunohistochemical panel, including TTF1, CDX2, Islet 1 and/or PAX8, in identifying metastatic pancreatic neuroendocrine tumors. A total of 110 primary neuroendocrine tumors (33 pancreatic, 31 pulmonary, 23 ileal, 14 rectal, and 9 gastric) and 73 metastatic neuroendocrine tumors (28 pancreatic, 5 pulmonary, 37 ileal, 1 rectal, 1 colonic, and 1 duodenal) were studied. Islet 1 and PAX8 were positive in 27/33 (82%) and 29/33 (88%), respectively, of primary pancreatic neuroendocrine tumors, and in 19/28 (68%) and 15/28 (54%), respectively, of metastatic pancreatic neuroendocrine tumors. No cases of primary (0/23) or metastatic (0/37) ileal neuroendocrine tumors were positive with either Islet 1 or PAX8. There was Islet 1 positivity in 2/31 (6%) primary pulmonary, 12/14 (86%) primary rectal, and 1/1 metastatic rectal neuroendocrine tumors, and PAX8 positivity in 7/31 (23%) primary pulmonary, 11/14 (79%) primary rectal, and 2/9 (22%) primary gastric neuroendocrine tumors. ROC curve analysis incorporating sensitivity and specificity data of immunohistochemical panels for metastatic pancreatic neuroendocrine tumors showed that a four-stain panel, including Islet 1, PAX8, TTF1, and CDX2 significantly outperformed a three-stain panel composed of PAX8, TTF1, and CDX2 (P ¼ 0.019), and also showed a trend for better performance compared with a three-stain panel composed of Islet 1, TTF1, and CDX2 (P ¼ 0.072). Both Islet 1 and PAX8 are reliable immunohistochemical markers for pancreatic neuroendocrine tumors and would be useful adjuncts to other markers (TTF1, CDX2) currently used to work up a metastatic neuroendocrine tumor of unknown primary.

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“…Over last 30 years, the incidence of NETs were still increased and its survival rates were still unsatisfied. Some studies suggested the resection of a GI-NET primary may improve survival [29][30] , which means the identification of the primary site is significant for it may effectively help for the selection and evaluation of treatment. According to statistics mentioned before, immunohistochemical staining for NKX2.2 should be applied in clinical management to identify the different form of NETs and guide therapy.…”

Section: Nkx22mentioning

confidence: 99%

The homeobox NKX and Neoplasms in Digestive system: a systematic review.

Yao¹,

Zhu²

2017

RAJAR

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ABSTRACT:The incidence of digestive system neoplasms is increasing over these years due to the limitation of prompt diagnosis and effective treatment. Homeobox genes are usually associated with development of cancer. Previous studies indicate that homeobox NKX transcription factors are partly involved in the development and progression of tumors in gastrointestinal tract. To summarize the different impact of NKX genes have on the digestive system, the interrelationship between each NKX genes and gastric-derived tumors is analyzed as much detail as possible. The results turn out that some of NKX genes may be used as a target to distinguish the primary site of cancer, or as a biomarker to predict the therapeutic effect and survival which is instructive and meaningful to the future medical managements. This review is a systematic synopsis of research on the homeobox genes NKX and digestive system neoplasms, with the focus on their functions and clinical significance.

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Operative resection of primary carcinoid neoplasms in patients with liver metastases yields significantly better survival

Cited by 175 publications

References 15 publications

The Role of Wireless Capsule Endoscopy (WCE) in the Detection of Occult Primary Neuroendocrine Tumors

The Role of Wireless Capsule Endoscopy (WCE) in the Detection of Occult Primary Neuroendocrine Tumors

Value of Islet 1 and PAX8 in identifying metastatic neuroendocrine tumors of pancreatic origin

The homeobox NKX and Neoplasms in Digestive system: a systematic review.

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