Scherübl H, Schwertner C, Steinberg J, Stölzel U, Pohl J, Dralle H, Klöppel G
Klinik für Innere Medizin-Gastroenterologie und GI Onkologie, Vivantes Klinikum Am Urban, Berlin.
Z Gastroenterol. 2010 Mar;48(3):406-13. doi: 10.1055/s-0028-1109862. Epub 2010 Feb 24.
Neuroendocrine tumors (NETs) of the small bowels are on the rise: in the US they have increased by 300-500% in the last 35 years. At the same time their prognosis has been much improved. Most NETs of the duodenum are nowadays detected "incidentally" and therefore recognized at an early stage. Duodenal NETs that are well differentiated, not larger than 10 mm in greatest dimension and limited to the mucosa/submucosa can be endoscopically resected. In NETs with a size between 10 mm and 20 mm the therapeutic strategy has to be individually discussed. Endoscopic ultrasound is the method of choice to determine tumor size and depth of infiltration. Surgery is indicated for well differentiated duodenal NETs greater than 20 mm, for localized sporadic gastrinomas and for localized poorly differentiated NE cancers. Surgery is also indicated for localized/regional ileal NETs. Advanced ileal NETs with a carcinoid syndrome are treated with stable somatostatin analogs. This treatment also significantly improves the (progression-free) survival in patients with metastatic NETs of the ileum. For optimal NET management tumor biology, type, localization and stage of the neoplasm as well as the individual situation of the patient have to be taken into account.
小肠神经内分泌肿瘤（NETs）的发病率正在上升：在美国，其发病率在过去35年中增长了300%-500%。与此同时，它们的预后有了很大改善。如今，大多数十二指肠NETs是“偶然”发现的，因此在早期就被识别出来。分化良好、最大直径不超过10毫米且局限于黏膜/黏膜下层的十二指肠NETs可通过内镜切除。对于大小在10毫米至20毫米之间的NETs，治疗策略必须进行个体化讨论。内镜超声是确定肿瘤大小和浸润深度的首选方法。对于直径大于20毫米的分化良好的十二指肠NETs、局限性散发性胃泌素瘤以及局限性低分化神经内分泌癌，建议进行手术治疗。对于局限性/区域性回肠NETs也建议进行手术治疗。伴有类癌综合征的晚期回肠NETs用长效生长抑素类似物治疗。这种治疗也显著提高了回肠转移性NETs患者的（无进展）生存率。为了实现最佳的NET管理，必须考虑肿瘤生物学、肿瘤类型、定位和分期以及患者的个体情况。
