The palliative benefit of aggressive surgical intervention for both hepatic and mesenteric metastases from neuroendocrine tumors

Update on Surgical Management of Small Bowel Neuroendocrine Tumors

“…Lymphadenectomy should precede enterectomy with possible ileoceccal valve preservation (10,18,28,35). R0 resection of both primary tumor and lymph node metastases is feasible in 80% of cases (10,18,19,36). Only in a minority of patients with bulky mesenteric masses is optimal debulking not feasible (36).…”

“…R0 resection of both primary tumor and lymph node metastases is feasible in 80% of cases (10,18,19,36). Only in a minority of patients with bulky mesenteric masses is optimal debulking not feasible (36). However, surgical intervention may alleviate symptoms (36).…”

Report from the 13th Annual Western Canadian Gastrointestinal Cancer Consensus Conference; Calgary, Alberta; September 8–10, 2011

“…However, many centres of excellence in nets have developed an aggressive surgical approach for these patients. Retrospective data have demonstrated improved survival in patients undergoing resection of the mesenteric disease compared with patients that did not (median survival: 11 years vs. 2.6 years) [37][38][39] . The suggestion is that resection of regional disease delayed onset of the obstruction and ischemia frequently seen in later stages of the disease.…”

“…The suggestion is that resection of regional disease delayed onset of the obstruction and ischemia frequently seen in later stages of the disease. Although these data are biased because of surgical selection, it does appear that aggressive surgical resection of regional disease may improve palliation in these patients, who are often experiencing ischemic symptoms 38,40 . Furthermore, some investigators have retrospectively shown an improved median pfs of 56 months compared with 25 months in patients whose primary tumour was resected in the face of advanced liver disease 41 .…”

“…Previous publications examining this topic gave the impression that a complete or R0 resection of metastatic disease was possible (similar to surgical resection of metastatic colorectal cancer). Recent work in this area has demonstrated that the disease pattern in these patients almost always involves multiple bilateral tumour deposits, often in a miliary pattern 38,45,46 . Consequently, it is almost always impossible to achieve an R0 resection.…”