The Surgical Management of Small Bowel Neuroendocrine Tumors: Consensus Guidelines of the North American Neuroendocrine Tumor Society

Overview

Journal Pancreas

Specialty Gastroenterology

Date 2017 Jun 14

PMID 28609357

Citations 130

Authors

James R Howe

Kenneth Cardona

Douglas L Fraker

Electron Kebebew

Brian R Untch

Yi-Zarn Wang

Calvin H Law

Eric H Liu

Michelle K Kim

Yusuf Menda

Brian G Morse

Emily K Bergsland

Jonathan R Strosberg

Eric K Nakakura

Rodney F Pommier

Affiliations

Soon will be listed here.

Abstract

Small bowel neuroendocrine tumors (SBNETs) have been increasing in frequency over the past decades, and are now the most common type of small bowel tumor. Consequently, general surgeons and surgical oncologists are seeing more patients with SBNETs in their practices than ever before. The management of these patients is often complex, owing to their secretion of hormones, frequent presentation with advanced disease, and difficulties with making the diagnosis of SBNETs. Despite these issues, even patients with advanced disease can have long-term survival. There are a number of scenarios which commonly arise in SBNET patients where it is difficult to determine the optimal management from the published data. To address these challenges for clinicians, a consensus conference was held assembling experts in the field to review and discuss the available literature and patterns of practice pertaining to specific management issues. This paper summarizes the important elements from these studies and the recommendations of the group for these questions regarding the management of SBNET patients.

Citing Articles

Evaluation of hand-assisted laparoscopic surgery of small intestinal neuroendocrine tumours as an alternative surgical treatment to open surgery.

Klimacek B, Akerstrom T, Anneback M, Hellman P, Norlen O, Stalberg P Langenbecks Arch Surg. 2025; 410(1):90.

PMID: 40047926 PMC: 11885331. DOI: 10.1007/s00423-025-03658-z.

Surgical Management of Gastroenteropancreatic Neuroendocrine Tumors.

Kenney L, Hughes M Cancers (Basel). 2025; 17(3).

PMID: 39941746 PMC: 11816225. DOI: 10.3390/cancers17030377.

Novel Surgical Initiatives in Gastroenteropancreatic Neuroendocrine Tumours.

Ritter A, Poppinga J, Steinkraus K, Hackert T, Niessen A Curr Oncol Rep. 2025; 27(2):157-167.

PMID: 39862354 PMC: 11861007. DOI: 10.1007/s11912-024-01632-4.

The radiologic spectrum of neuroendocrine tumors in emergent care.

Sahu A, Patlas M, Jajodia A Rev Endocr Metab Disord. 2025; .

PMID: 39745542 DOI: 10.1007/s11154-024-09940-7.

ASO Author Reflections: The Utility of PRRT upon Progression After Resection and Cytoreduction of GEP-NETs.

Howe J, Sherman S, Dillon J Ann Surg Oncol. 2024; 32(2):1187-1188.

PMID: 39645558 DOI: 10.1245/s10434-024-16666-y.

References

Jacobs R, Bai S, Hindman N, Shah P . Carcinoid abdominal crisis: a case report. J Surg Oncol. 2014; 110(3):348-51. DOI: 10.1002/jso.23650. View

McCulloch P, Niita M, Kazi H, Gama-Rodrigues J . Gastrectomy with extended lymphadenectomy for primary treatment of gastric cancer. Br J Surg. 2005; 92(1):5-13. DOI: 10.1002/bjs.4839. View

Chamberlain R, Canes D, Brown K, Saltz L, Jarnagin W, Fong Y . Hepatic neuroendocrine metastases: does intervention alter outcomes?. J Am Coll Surg. 2000; 190(4):432-45. DOI: 10.1016/s1072-7515(00)00222-2. View

Morrisroe K, Sim I, McLachlan K, Inder W . Carcinoid crisis induced by repeated abdominal examination. Intern Med J. 2012; 42(3):342-4. DOI: 10.1111/j.1445-5994.2012.02719.x. View

Walker R, Smith G, Liu E, Moore B, Clanton J, Stabin M . Measured human dosimetry of 68Ga-DOTATATE. J Nucl Med. 2013; 54(6):855-60. PMC: 4472480. DOI: 10.2967/jnumed.112.114165. View

Glazer E, Tseng J, Al-Refaie W, Solorzano C, Liu P, Willborn K . Long-term survival after surgical management of neuroendocrine hepatic metastases. HPB (Oxford). 2010; 12(6):427-33. PMC: 3028584. DOI: 10.1111/j.1477-2574.2010.00198.x. View

Yao J, Fazio N, Singh S, Buzzoni R, Carnaghi C, Wolin E . Everolimus for the treatment of advanced, non-functional neuroendocrine tumours of the lung or gastrointestinal tract (RADIANT-4): a randomised, placebo-controlled, phase 3 study. Lancet. 2015; 387(10022):968-977. PMC: 6063317. DOI: 10.1016/S0140-6736(15)00817-X. View

Wang S, Parekh J, Zuraek M, Venook A, Bergsland E, Warren R . Identification of unknown primary tumors in patients with neuroendocrine liver metastases. Arch Surg. 2010; 145(3):276-80. DOI: 10.1001/archsurg.2010.10. View

McEntee G, Nagorney D, Kvols L, MOERTEL C, Grant C . Cytoreductive hepatic surgery for neuroendocrine tumors. Surgery. 1990; 108(6):1091-6. View

10.

Sakorafas G, Milingos D, Peros G . Asymptomatic cholelithiasis: is cholecystectomy really needed? A critical reappraisal 15 years after the introduction of laparoscopic cholecystectomy. Dig Dis Sci. 2007; 52(5):1313-25. DOI: 10.1007/s10620-006-9107-3. View

11.

Woltering E, Wright A, Stevens M, Wang Y, Boudreaux J, Mamikunian G . Development of effective prophylaxis against intraoperative carcinoid crisis. J Clin Anesth. 2016; 32:189-93. DOI: 10.1016/j.jclinane.2016.03.008. View

12.

Yao J, Hassan M, Phan A, Dagohoy C, Leary C, Mares J . One hundred years after "carcinoid": epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008; 26(18):3063-72. DOI: 10.1200/JCO.2007.15.4377. View

13.

Sadowski S, Neychev V, Millo C, Shih J, Nilubol N, Herscovitch P . Prospective Study of 68Ga-DOTATATE Positron Emission Tomography/Computed Tomography for Detecting Gastro-Entero-Pancreatic Neuroendocrine Tumors and Unknown Primary Sites. J Clin Oncol. 2015; 34(6):588-96. PMC: 4872030. DOI: 10.1200/JCO.2015.64.0987. View

14.

Dahdaleh F, Calva-Cerqueira D, Carr J, Liao J, Mezhir J, ODorisio T . Comparison of clinicopathologic factors in 122 patients with resected pancreatic and ileal neuroendocrine tumors from a single institution. Ann Surg Oncol. 2011; 19(3):966-72. DOI: 10.1245/s10434-011-1997-4. View

15.

Landry C, Lin H, Phan A, Charnsangavej C, Abdalla E, Aloia T . Resection of at-risk mesenteric lymph nodes is associated with improved survival in patients with small bowel neuroendocrine tumors. World J Surg. 2013; 37(7):1695-700. PMC: 3881007. DOI: 10.1007/s00268-013-1918-8. View

16.

Kerstrom G, Hellman P, Hessman O . Midgut carcinoid tumours: surgical treatment and prognosis. Best Pract Res Clin Gastroenterol. 2005; 19(5):717-28. DOI: 10.1016/j.bpg.2005.05.005. View

17.

Kim K, Krajewski K, Nishino M, Jagannathan J, Shinagare A, Tirumani S . Update on the management of gastroenteropancreatic neuroendocrine tumors with emphasis on the role of imaging. AJR Am J Roentgenol. 2013; 201(4):811-24. PMC: 3970265. DOI: 10.2214/AJR.12.10240. View

18.

Maxwell J, Sherman S, Stashek K, ODorisio T, Bellizzi A, Howe J . A practical method to determine the site of unknown primary in metastatic neuroendocrine tumors. Surgery. 2014; 156(6):1359-65. PMC: 4254437. DOI: 10.1016/j.surg.2014.08.008. View

19.

Al Kharrat H, Taubin H . Carcinoid crisis induced by external manipulation of liver metastasis. J Clin Gastroenterol. 2002; 36(1):87-8. DOI: 10.1097/00004836-200301000-00031. View

20.

Makridis C, Rastad J, Oberg K, Akerstrom G . Progression of metastases and symptom improvement from laparotomy in midgut carcinoid tumors. World J Surg. 1996; 20(7):900-6; discussion 907. DOI: 10.1007/s002689900137. View