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Small bowel neuroendocrine tumors: A critical analysis of diagnostic work‐up and operative approach
Author(s) -
Ethun Cecilia G.,
Postlewait Lauren M.,
Baptiste Gillian G.,
McInnis Mia R.,
Cardona Kenneth,
Russell Maria C.,
Kooby David A.,
Staley Charles A.,
Maithel Shishir K.
Publication year - 2016
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24390
Subject(s) - medicine , neuroendocrine tumors , capsule endoscopy , occult , enteroscopy , work up , endoscopy , surgery , radiology , pathology , alternative medicine
Background Small bowel neuroendocrine tumors (SB‐NETs) are often small, multifocal, difficult to localize preoperatively, and can be overlooked during operative exploration. The optimal work‐up and operative approach is unknown. Methods Patients who underwent resection of SB‐NETs at a single‐institution from 2000 to 2014 were included. Primary aim was to describe the diagnostic work‐up and compare minimally invasive (MIS) to open resection. Results Ninety‐three patients underwent resection for SB‐NETs. About 71% were symptomatic and on average underwent three diagnostic tests: 45% had octreoscans (85% diagnostic yield); 11% had SB‐enteroscopy (10% yield); 19% had capsule endoscopy (83% yield, but identified the correct tumor number in only 21%). About 27 pts underwent MIS versus 66 open. MIS pts were younger (56 vs. 61 yrs; P = 0.035), and less likely to have obstruction (4% vs. 24%; P = 0.019) and metastases (19% vs. 44%; P = 0.038). Compared to open, MIS had smaller (1.7 vs. 2.4 cm; P = 0.03) and fewer tumors resected (2 vs. 5; P = 0.049), but similar LN yield (13 vs. 12; P = 0.7). In non‐metastatic, curative‐intent resections, MIS still resected fewer tumors compared to open (1.5 vs. 4; P = 0.034). Conclusion Capsule endoscopy may be better than small bowel enteroscopy at identifying occult SB‐NETs, but may underestimate tumor burden. While MIS may be appropriate in select patients, recognizing the limitations of preoperative evaluation is critical for these tumors, as heightened operative vigilance is often required. J. Surg. Oncol. 2016;114:671–676 . © 2016 Wiley Periodicals, Inc.