Small Bowel Neuroendocrine Tumors: Focus on Pathologic Aspects and Controversial Surgical Issues

AbstractPurpose of the ReviewThe aim of the review is to present an updated overview on the pathologic aspects and the surgical approach to small bowel neuroendocrine tumors, focusing on the following debated issues: role of laparoscopic surgery, lymph node dissection, prophylactic cholecystectomy, mesenteric fibrosis, and surgery of distant metastases.Recent FindingsNeuroendocrine tumors of the small intestine, formerly known as midgut carcinoid tumors, are a rather rare disease with an incidence of less than 1 per 100,000 in the general population. However, the neuroendocrine tumors of the small intestine are among the most common malignancies, accounting for more than 20% of all neuroendocrine tumors in Europe and the USA. Preoperative diagnosis of neuroendocrine tumors of the small intestine is challenging. Diagnosis is often late due to the rather unspecific clinical complaints. At the time of the operation, a third of the patients already have hepatic metastasis. The biology of these tumors is different from other neuroendocrine neoplasms of the digestive tract. There is no correlation between tumor size and tumor stage. Also, small tumors  <  10 mm can already have lymphatic or distant metastases, so that the radical nature of the operation is not determined by the size of the primary tumor. Colon-sparing resection with systematic lymphadenectomy along the superior mesenteric artery and removal of the retropancreatic lymph nodes is a lso recommended in the loca...
Source: Current Surgery Reports - Category: Surgery Source Type: research