Aggressive Surgical Approach to the Management of Neuroendocrine Tumors: A Report of 1,000 Surgical Cytoreductions by a Single Institution.

Aggressive Surgical Approach to the Management of Neuroendocrine Tumors: A Report of 1,000 Surgical Cytoreductions by a Single Institution.

J Am Coll Surg. 2017 Jan 11;:

Authors: Woltering EA, Voros BA, Beyer DT, Wang YZ, Thiagarajan R, Ryan P, Wright A, Ramirez RA, Ricks MJ, Boudreaux JP

Abstract
BACKGROUND: Neuroendocrine tumors (NETs) are rare neoplasms. Our group has treated over 2,000 NET patients and has performed over 1,000 surgical cytoreductive procedures.
STUDY DESIGN: Records of 834 NET patients who underwent surgical cytoreduction at our institution were reviewed. Demographic information, intraoperative findings, extent of disease, complications, and survival rates were calculated.
RESULTS: 800 patients underwent 1,001 cytoreductive surgeries. Sixty-five percent had small bowel primaries. 138 patients presented with an unknown primary site, which was localized intraoperatively in 89% of these cases. The intraoperative complication rate was 9%. The incidence of intraoperative carcinoid crisis was 1%. Mean operative time was 368 ± 146 minutes. Mean hospital stay was 9 ± 10 days. Minor postoperative complications occurred following 43% of procedures and major postoperative complications were noted after 19% of procedures. The 30-day postoperative mortality rate was 2%. Median overall survival (OS) for pancreatic NETs was 124 months. The 5-, 10- and 20-year OS for pancreatic NETs were 67%, 51% and 36%, respectively. The life expectancy difference [between OS and actuarial survival (AS)] after surgical cytoreduction for pancreatic NETs was 16.6 years. Median OS for small bowel NETs was 161 months. The 5-, 10- and 20-year OS for small bowel NETs were 84%, 67% and 31%, respectively. The life expectancy difference after surgical cytoreduction for small bowel NETs was 11.7 years.
CONCLUSIONS: Surgical cytoreduction in NET patients has low morbidity and mortality rates and results in prolonged survival. We believe that surgical cytoreduction should play a major role in the care of patients with NETs.

PMID: 28088602 [PubMed - as supplied by publisher]

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