Novel Surgical Initiatives in Gastroenteropancreatic Neuroendocrine Tumours

Overview

Journal Curr Oncol Rep

Publisher Current Science

Date 2025 Jan 25

PMID 39862354

Authors

Alina S Ritter

Jelte Poppinga

Kira C Steinkraus

Thilo Hackert

Anna Niessen

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: Neuroendocrine tumours (NET) are rare entities arising from hormone producing cells in the gastroentero-pancreatic (GEP) tract. Surgery is the most common treatment of GEP-NETs.

Recent Findings: Improvements in surgical techniques allow for more locally advanced and metastasised GEP-NETs to be resected. Laparoscopic and robotically--assisted approaches are increasingly being utilised in the resection of selected GEP-NETs and are facilitated by novel intraoperative tumour localisation tools and parenchyma-sparing methods. At the same time, some authors suggest that indications for formal resections of small well differentiated non-functioning pancreatic NETs and appendiceal NETs should be more restrictive. Advancements in surgery allows for tissue-sparing resections of GEP-NETs. Indications for surgical resection and the extent of the procedure are highly dependent on GEP-NET size, localisation and grading. Robotically assisted surgeries with intraoperative ultrasound and visualisation methods as well as vessel-sparing radical retrograde lymphadenectomies for small intestinal NETs seem to be the future of GEP-NET surgery.

References

Pavone M, Seeliger B, Teodorico E, Goglia M, Taliento C, Bizzarri N . Ultrasound-guided robotic surgical procedures: a systematic review. Surg Endosc. 2024; 38(5):2359-2370. PMC: 11078854. DOI: 10.1007/s00464-024-10772-4. View

Kose E, Rudin A, Kahramangil B, Moore E, Aydin H, Donmez M . Autofluorescence imaging of parathyroid glands: An assessment of potential indications. Surgery. 2019; 167(1):173-179. DOI: 10.1016/j.surg.2019.04.072. View

Partelli S, Gaujoux S, Boninsegna L, Cherif R, Crippa S, Couvelard A . Pattern and clinical predictors of lymph node involvement in nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs). JAMA Surg. 2013; 148(10):932-9. DOI: 10.1001/jamasurg.2013.3376. View

Bettini R, Mantovani W, Boninsegna L, Crippa S, Capelli P, Bassi C . Primary tumour resection in metastatic nonfunctioning pancreatic endocrine carcinomas. Dig Liver Dis. 2008; 41(1):49-55. DOI: 10.1016/j.dld.2008.03.015. View

Wong W, Perez Holguin R, Olecki E, Stahl K, Dixon M, Peng J . Predictors and Outcomes of Minimally Invasive Surgery for Small Bowel Neuroendocrine Tumors : Minimally Invasive Surgery for SBNETs. J Gastrointest Surg. 2022; 26(6):1252-1265. DOI: 10.1007/s11605-022-05264-6. View

Partelli S, Bertani E, Bartolomei M, Perali C, Muffatti F, Grana C . Peptide receptor radionuclide therapy as neoadjuvant therapy for resectable or potentially resectable pancreatic neuroendocrine neoplasms. Surgery. 2017; 163(4):761-767. DOI: 10.1016/j.surg.2017.11.007. View

Zhou Y, Zhao M, Wu L, Ye F, Si X . Short- and long-term outcomes after enucleation of pancreatic tumors: An evidence-based assessment. Pancreatology. 2016; 16(6):1092-1098. DOI: 10.1016/j.pan.2016.07.006. View

Zaidi M, Lopez-Aguiar A, Dillhoff M, Beal E, Poultsides G, Makris E . Prognostic Role of Lymph Node Positivity and Number of Lymph Nodes Needed for Accurately Staging Small-Bowel Neuroendocrine Tumors. JAMA Surg. 2018; 154(2):134-140. PMC: 6439661. DOI: 10.1001/jamasurg.2018.3865. View

Eneholm J, Beka E, Kotan R, Gimm O . A retrospective study comparing minimally invasive versus open surgical resection of small intestinal neuroendocrine neoplasms at a tertiary referral center. Eur J Surg Oncol. 2024; 50(2):107936. DOI: 10.1016/j.ejso.2023.107936. View

10.

Howe J, Cardona K, Fraker D, Kebebew E, Untch B, Wang Y . The Surgical Management of Small Bowel Neuroendocrine Tumors: Consensus Guidelines of the North American Neuroendocrine Tumor Society. Pancreas. 2017; 46(6):715-731. PMC: 5502737. DOI: 10.1097/MPA.0000000000000846. View

11.

Pape U, Niederle B, Costa F, Gross D, Kelestimur F, Kianmanesh R . ENETS Consensus Guidelines for Neuroendocrine Neoplasms of the Appendix (Excluding Goblet Cell Carcinomas). Neuroendocrinology. 2016; 103(2):144-52. DOI: 10.1159/000443165. View

12.

Niessen A, Schimmack S, Lewosinska M, Hinz U, Bechtiger F, Hackert T . Lymph node metastases and recurrence in pancreatic neuroendocrine neoplasms. Surgery. 2022; 172(6):1791-1799. DOI: 10.1016/j.surg.2022.08.020. View

13.

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

14.

Walsh J, Schaeffer D, Kirsch R, Pollett A, Manzoni M, Riddell R . Ileal "carcinoid" tumors-small size belies deadly intent: high rate of nodal metastasis in tumors ≤1 cm in size. Hum Pathol. 2016; 56:123-7. DOI: 10.1016/j.humpath.2016.05.023. View

15.

Alander J, Kaartinen I, Laakso A, Patila T, Spillmann T, Tuchin V . A review of indocyanine green fluorescent imaging in surgery. Int J Biomed Imaging. 2012; 2012:940585. PMC: 3346977. DOI: 10.1155/2012/940585. View

16.

Zheng J, Pulvirenti A, Javed A, Michelakos T, Paniccia A, Lee K . Minimally Invasive vs Open Pancreatectomy for Pancreatic Neuroendocrine Tumors: Multi-Institutional 10-Year Experience of 1,023 Patients. J Am Coll Surg. 2022; 235(2):315-330. DOI: 10.1097/XCS.0000000000000257. View

17.

Steffen T, Ebinger S, Warschkow R, Luthi C, Schmied B, Clerici T . Long-Term Survival is not Impaired After the Complete Resection of Neuroendocrine Tumors of the Appendix. World J Surg. 2015; 39(11):2670-6. DOI: 10.1007/s00268-015-3164-8. View

18.

Rinke A, Ambrosini V, Dromain C, Garcia-Carbonero R, Haji A, Koumarianou A . European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for colorectal neuroendocrine tumours. J Neuroendocrinol. 2023; 35(6):e13309. DOI: 10.1111/jne.13309. View

19.

Howe J, Merchant N, Conrad C, Keutgen X, Hallet J, Drebin J . The North American Neuroendocrine Tumor Society Consensus Paper on the Surgical Management of Pancreatic Neuroendocrine Tumors. Pancreas. 2019; 49(1):1-33. PMC: 7029300. DOI: 10.1097/MPA.0000000000001454. View

20.

Kacmaz E, Slooter M, van Dijkum E, Tanis P, Engelsman A . Fluorescence angiography guided resection of small bowel neuroendocrine neoplasms with mesenteric lymph node metastases. Eur J Surg Oncol. 2020; 47(7):1611-1615. DOI: 10.1016/j.ejso.2020.12.008. View