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      Surgery and Perioperative Management in Small Intestinal Neuroendocrine Tumors

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          Abstract

          Small-intestinal neuroendocrine tumors (SI-NETs) are the most prevalent small bowel neoplasms with an increasing frequency. In the multimodal management of SI-NETs, surgery plays a key role, either in curative intent, even if R0 resection is feasible in only 20% of patients due to advanced stage at diagnosis, or palliative intent. Surgeons must be informed about the specific surgical management of SI-NETs according to their hormonal secretion, their usual dissemination at the time of diagnosis and the need for bowel-preserving surgery to avoid short bowel syndrome. The aim of this paper is to review the surgical indications and techniques, and perioperative and postoperative management of SI-NETs.

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          Lanreotide in metastatic enteropancreatic neuroendocrine tumors.

          Martyn Caplin, Marianne Pavel, Jarosław B. Ćwikła … (2014)
          Somatostatin analogues are commonly used to treat symptoms associated with hormone hypersecretion in neuroendocrine tumors; however, data on their antitumor effects are limited. We conducted a randomized, double-blind, placebo-controlled, multinational study of the somatostatin analogue lanreotide in patients with advanced, well-differentiated or moderately differentiated, nonfunctioning, somatostatin receptor-positive neuroendocrine tumors of grade 1 or 2 (a tumor proliferation index [on staining for the Ki-67 antigen] of <10%) and documented disease-progression status. The tumors originated in the pancreas, midgut, or hindgut or were of unknown origin. Patients were randomly assigned to receive an extended-release aqueous-gel formulation of lanreotide (Autogel [known in the United States as Depot], Ipsen) at a dose of 120 mg (101 patients) or placebo (103 patients) once every 28 days for 96 weeks. The primary end point was progression-free survival, defined as the time to disease progression (according to the Response Evaluation Criteria in Solid Tumors, version 1.0) or death. Secondary end points included overall survival, quality of life (assessed with the European Organization for Research and Treatment of Cancer questionnaires QLQ-C30 and QLQ-GI.NET21), and safety. Most patients (96%) had no tumor progression in the 3 to 6 months before randomization, and 33% had hepatic tumor volumes greater than 25%. Lanreotide, as compared with placebo, was associated with significantly prolonged progression-free survival (median not reached vs. median of 18.0 months, P<0.001 by the stratified log-rank test; hazard ratio for progression or death, 0.47; 95% confidence interval [CI], 0.30 to 0.73). The estimated rates of progression-free survival at 24 months were 65.1% (95% CI, 54.0 to 74.1) in the lanreotide group and 33.0% (95% CI, 23.0 to 43.3) in the placebo group. The therapeutic effect in predefined subgroups was generally consistent with that in the overall population, with the exception of small subgroups in which confidence intervals were wide. There were no significant between-group differences in quality of life or overall survival. The most common treatment-related adverse event was diarrhea (in 26% of the patients in the lanreotide group and 9% of those in the placebo group). Lanreotide was associated with significantly prolonged progression-free survival among patients with metastatic enteropancreatic neuroendocrine tumors of grade 1 or 2 (Ki-67 <10%). (Funded by Ipsen; CLARINET ClinicalTrials.gov number, NCT00353496; EudraCT 2005-004904-35.).
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            ENETS Consensus Guidelines Update for the Management of Distant Metastatic Disease of Intestinal, Pancreatic, Bronchial Neuroendocrine Neoplasms (NEN) and NEN of Unknown Primary Site

            M. Pavel, D. O''Toole, F. Costa … (2016)
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              EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones.

              (2016)
              Article 0 comments Cited 133 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Clin Med
                Journal ID (iso-abbrev): J Clin Med
                Journal ID (publisher-id): jcm
                Title: Journal of Clinical Medicine
                Publisher: MDPI
                ISSN (Electronic): 2077-0383
                Publication date (Electronic): 21 July 2020
                Publication date Collection: July 2020
                Volume: 9
                Issue: 7
                Electronic Location Identifier: 2319
                Affiliations
                [1 ]Digestive Surgery Department, Reims University Hospital, Robert Debré Hospital, F-51092 Reims, France; chammoutene@ 123456chu-reims.fr (C.H.); rkianmanesh@ 123456chu-reims.fr (R.K.)
                [2 ]Clinical Research Department, Reims University Hospital, Robert Debré Hospital, F-51092 Reims, France
                [3 ]Department of Hepato-Gastroenterology and Digestive Oncology, Reims University Hospital, Robert Debré Hospital, F-51092 Reims, France; mperrier@ 123456chu-reims.fr (M.P.); gcadiot@ 123456chu-reims.fr (G.C.)
                Author notes
                Author information
                https://orcid.org/0000-0002-4528-5471
                Article
                Publisher ID: jcm-09-02319
                DOI: 10.3390/jcm9072319
                PMC ID: 7408509
                PubMed ID: 32708330
                SO-VID: db5e790a-e159-485a-a495-bb913e0946c4
                Copyright © © 2020 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 19 June 2020
                Date accepted : 16 July 2020
                Categories
                Subject: Review

                Keywords: small bowel neuroendocrine tumor,surgery,carcinoid syndrome,carcinoid crisis
                Data availability:
                Keywords: small bowel neuroendocrine tumor, surgery, carcinoid syndrome, carcinoid crisis

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