Palliative Surgery in Advanced Small Intestinal Neuroendocrine Tumors Abstract #2092

Introduction: Small intestinal neuroendocrine tumours (SI-NETs) are known to develop mesenteric metastasis and fibrosis. Since this can induce intestinal obstruction, edema and ischaemia, prophylactic palliative resection of the primary tumour and mesenteric mass is often recommended in case of advanced disease but the evidence is disputable.
Aim(s): We performed the largest retrospective study so far to assess the effect of prophylactic palliative surgery in advanced SI-NETs.
Materials and methods: A retrospective analysis of 538 patients with proven SI-NETs ENETS stage III or IV disease at diagnosis and available CT-imaging was performed. Clinical characteristics as well as the effect of abdominal surgery on overall survival were assessed.
Conference: 15th Annual ENETS conference (2018)
Category: Surgical treatment and Ablative Therapies
Presenting Author: Drs. Anela Blazevic

To read results and conclusion, please login ...

Further abstracts you may be interested in

#14 Radioguided surgery in NET: First impression with Ga-68 labeled somatostatin analogues
Introduction: Neuroendocrine tumors (NET) constitute a heterogenous group of neoplasms. The development of Gallium-68-labeled somatostatin analogues, such as DOTA-NOC or DOTA-TOC, PET/CT have dramatically improved the diagnosis of neuroendocrine tumors. Surgery remains the treatment of choice for localized disease as well as metastatic disease. The aims of surgery are: improvement of symptoms, reduction of tumor mass / burden and to give better quality of life to patients. Recurrent laparotomies often lead to multiple adhesions and altered anatomy. So it is increasingly difficult for imaging physicians and surgeons to separate non-malignant from malignant tissue.
Conference: 7th Annual ENETS Conference (2010)
Category: Clinical
Presenting Author: Dr. Daniel Kaemmerer
#18 Long-acting release octreotide induce complete response in type 1 gastric carcinoid tumors
Introduction: Gastric endocrine tumors (GET) are increasingly recognized due to expanding indications of upper gastrointestinal endoscopy. Often silent and benign, GET may also be aggressive when sporadic and may sometimes mimic the course of gastric adenocarcinoma. Current incidence of GETs is estimated at around 8% of digestive endocrine tumors. Yearly age-adjusted incidence is around 0.2 per population of 100,000. Gastric carcinoids (ECLomas) develop from gastric enterochromaffin-like cells (ECL cells) in response to chronically elevated gastrin. Type 1 tumors (ECLomas in the course of atrophic gastritis) may occur in conditions of achlorhydria secondary to auto-immune atrophic fundic gastritis. It occurs mostly in women and they are non-functioning tumors, typically found during upper GI endoscopy performed for dyspepsia. ECLomas present frequently as multiple polyps, usually < 1 cm in diameter in the gastric fundus. Type 1 tumors are almost exclusively benign lesions with little risk of deep invasion of the gastric parietal wall. The neoplastic ECL cells become progressively dedifferentiated with an increasing number of Ki-67 immunoreactive (IR) cell nuclei. In addition, there is a substantial decrease in argynophil and IR NE cells that can be visualized by conventional methods. ECLomas secondary to hypergastrinemia should be closely followed for signs of clinical and histopathological tumor progression. Such ECLomas deserve early, active, radical surgical treatment.
Traditionally, gastric carcinoid type 1 (GCA1s) are endoscopically or surgically removed, depending on the number, appearance and size of the tumors. Antrectomy, with surgical excision of the majority of the G cells, is thought to facilitate regression of these tumors by removing the source of excessive gastrin secretion; however, the long-term benefits of antrectomy still remain uncertain. Although proton pump inhibitors are effective in reducing hypergastrinemia-induced gastric acid hypersecretion in GCA2, they do not affect ECL-cell hyperplasia, and therefore their role in GCA1 is limited. Moreover, in selected cases, significant reduction of hypergastrinemia does not prevent development of ECL carcinoid, suggesting that, in addition to hypergastrinemia, other pathogenic or genetic factors may be involved. Treatment with somatostatin analogues (SSA) might impede ECL-cell hyperplasia by suppressing gastrin secretion and/or by a direct anti-proliferative effect on ECL cells. Treatment with SSAs in GCA1 leads to a substantial tumor load reduction, with a concomitant decrease of serum gastrin levels. Published data indicate an important anti-proliferative effect of SSA on ECL cells, providing clinical benefit and obviating, at least temporarily, the need for invasive therapies for GCA1. Morphometric studies demonstrated that, while antrectomy specifically decreased the volume of ECL cells versus the total volume of endocrine cells, octreotide reduces the overall endocrine cell volume. Although the number of treated patients is small, it has been suggested that SSA may exert important anti-proliferative effects either directly, by inhibiting ECL-cells proliferation, or indirectly through suppression of gastrin hypersecretion.
Conference: 7th Annual ENETS Conference (2010)
Category: Clinical
Presenting Author: MD Ricardo Caponero
#20 Paraneoplastic antigen Ma2 (PNMA2) auto-antibodies as biomarkers for early small intestine neuroendocrine tumors detection
Introduction: Small intestine neuroendocrine tumors (NETs) comprise well-differentiated NET (benign carcinoid), well-differentiated neuroendocrine carcinoma (malignant carcinoid) and poorly differentiated neuroendocrine carcinoma (NEC). The majority of NET patients have developed liver metastases at the time of diagnosis and surgery is then seldom curative. Novel predictive, diagnostic and prognostic markers are thus needed to improve our capabilities to diagnose and cure these tumors. We have previously identified six novel marker genes for neuroendocrine tumor cells by using Affymetrix microarrays and advanced bioinformatics. One of this markers, the paraneoplastic antigen Ma2 (PNMA2), which is normally expressed only in nervous tissue, can in the process of carcinogenesis be detected in tumors located outside the nervous system. The finding that Ma2 is expressed in small intestine neuroendocrine primary tumors and their metastases made it interesting to screen whether antibodies against Ma2 are present in the serum of NET patients.
Conference: 7th Annual ENETS Conference (2010)
Category: Basic
Presenting Author: PhD Valeria Giandomenico
Authors: Cui T, Elgue G, Li S C, Hurtig M, ...
#37 Gastric GIST with synchronous neuroendocrine tumor of the pancreas, Case Report and Literature Review
Introduction: The Gastrointestinal Stromal Tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. These are rare tumors with an incidence of 15 new cases per million per year. They often occur in individuals over the age of 40 years, without gender predominance. The clinical behavior is variable and benign tumors are the most common. They can develop anywhere in the GI tract, but are more frequent in the stomach and small intestine. The primary treatment, when located, is the surgical resection, which can be complemented with the use of imatinib.
The occurrence of neuroendocrine tumors of the pancreas is rare, representing 1-5% of pancreatic cancers, and it is estimated that its incidence does not exceed 5 to one million. The tumors considered nonfunctioning (15-32% of pancreatic neuroendocrine tumors) are not associated with any syndrome, and are usually incidental. They have a slight predominance in males, and are more frequent in the 6th decade of life. Nonfunctioning tumors of islet cells are virtually all malignant tumors, and the treatment consists of surgical resection.
Conference: 7th Annual ENETS Conference (2010)
Category: Clinical
Presenting Author: Dra Amelia B Tavares
#47 Plasma CCN2/connective tissue growth factor is associated with right ventricular dysfunction in Patients with Neuroendocrine Tumors
Introduction: Carcinoid heart disease (CHD) is a known complication of neuroendocrine tumors (NETs), particularly of those arising from the small intestine, appendix and proximal colon (previously known as mid-gut carcinoids). CHD is characterized by right heart fibrotic lesions and has traditionally been defined by the degree of valvular involvement, most commonly in the form of tricuspid regurgitation. Right ventricular (RV) dysfunction due to mural involvement may also be a manifestation. Connective tissue growth factor (CCN2) is upregulated in many fibrotic disorders. Increased tumor expression of CCN2 has been shown in patients with small intestinal NETs associated with peritoneal fibrosis. At present, its role in carcinoid heart disease is unknown.
Conference: 7th Annual ENETS Conference (2010)
Category: Clinical
Presenting Author: Dr. Deidi S Bergestuen