Extensive ""multitasking"" surgery for advanced neuroendocrine tumors is safe and effective

#137

Introduction: Management of advanced NETs is controversial, related to degree of intervention; the pendulum is swinging towards a more aggressive interventional approach. Our Center's philosophy is to offer a systematic, planned multimodality treatment for patients with advanced NETs.

Aim(s): To demonstrate that a proactive therapeutic atttitude achieves significant debulking and, consequently major improvement in symptoms and quality of life.

Materials and methods: From 1994 to 2007, 57 patients (ages 26-78, mean 56), 21 males-36 females underwent extensive surgery for advanced NETs. Thirty-five patients presented with typical carcinoid and significant syndrome, mostly originating in the small bowel. All patients were fully evaluated by serum markers, nuclear and radiological imaging and echocardiogram to assess cardiac valvular involvement. All surgeries in this series were performed by one surgeon (MS) and included: resection of primary tumor(s), lymph nodes, peritoneal and retroperitoneal metastases, liver resection(s), cryo/radiofrequency ablation for liver metastases and cholecystectomy. Several patients underwent pancreatectomy and hysterectomy/salpingo-oophorectomy. Eight patients had significant tricuspid and pulmonary valve disease and underwent valve replacement prior to abdominal surgery. Samples of all resected tissues were collected for in vitro tumor cell culture to assess for chemo sensitivity/resistance and expression of growth factors such as EGF and VEGF, to help personalize postoperative treatment options. All patients were pre-treated with short- and long-acting Octreotide. Perioperative high dose continuous intravenous infusion of Octreotide was administered and tapered progressively after surgery. Follow-up of minimum of two years.

Conference: 7th Annual ENETSConcerence (2010)

Presenting Author: Shafir M

Authors: Shafir M, Warner R, Gonsalves S, Zacks J, Ratner L,

Keywords: extensive surgery, advanced NETs,