Pasquer Arnaud, Walter Thomas, Hervieu Valérie, Forestier Julien, Scoazec Jean-Yves, Lombard-Bohas Catherine, Poncet Gilles
Hospices Civils de Lyon, Hôpital Edouard Herriot, Chirurgie digestive, Lyon Cedex 03, France.
Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Gastroentérologie et d'oncologie digestive, Lyon Cedex 03, France.
Ann Surg Oncol. 2015 Dec;22 Suppl 3:S742-9. doi: 10.1245/s10434-015-4620-2. Epub 2015 May 27.
Small bowel neuroendocrine tumors (SB-NETs) are characterized by two main features: they usually are metastatic at diagnosis and multiple in 30 % of cases. As such, SB-NETs require specific surgical management. This retrospective study examined local recurrence, survival, and prognosis of SB-NETs after adapted surgery.
All consecutive patients with SB-NETs who underwent resection of at least one primary tumor between 1 January 2000 and 1 January 2013 were analyzed. The preoperative morphologic workup, histologic classification, and metastatic lymph node (LN) ratio (LNs involved/removed) were recorded.
The study enrolled 107 patients, 35 (33 %) of whom had multiple SB-NETs (range 1-44; mean 3.1). Preoperative imaging and perioperative surgical examination missed 61 and 33 % of SB-NETs, respectively, in contrast to pathologic examination. Of the 107 patients, 43 % had carcinoid syndrome, 70 % had metastatic disease, and 90 % had LN involvement. The median number of LNs retrieved was 12 (range 1-69). The LN ratio (LNs involved/removed) was 0.25. The highest tumoral grades were G1 (in 61 % of patients) and G2 (in 37 % of patients). Of the 107 patients, 13 (12 %) had local LN recurrence. The rate of LN recurrence-free survival at 5 years was 88 %. The median overall survival (OS) time was 128 months (range 91-165 months). In the multivariate analysis, high chromogranin A (CgA) levels and peritoneal carcinomatosis were significantly associated with shorter OS.
Systematic palpation of the entire small bowel detects more multiple NETs than preoperative imaging. Systematic surgery with extensive LN resection is associated with low local recurrence. High CgA levels and carcinomatosis are linked with shorter survival.
小肠神经内分泌肿瘤（SB-NETs）具有两个主要特征：它们在诊断时通常已发生转移，且30%的病例为多发。因此，SB-NETs需要特定的手术治疗。这项回顾性研究探讨了适应性手术后SB-NETs的局部复发、生存及预后情况。
分析了2000年1月1日至2013年1月1日期间所有连续接受至少一个原发性肿瘤切除的SB-NETs患者。记录术前形态学检查、组织学分类及转移淋巴结（LN）比例（受累淋巴结/切除淋巴结）。
该研究纳入了107例患者，其中35例（33%）患有多发SB-NETs（范围为1至44个；平均3.1个）。与病理检查相比，术前影像学检查和围手术期手术检查分别漏诊了61%和33%的SB-NETs。107例患者中，43%有类癌综合征，70%有转移性疾病，90%有淋巴结受累。切除淋巴结的中位数为12个（范围为1至69个）。LN比例（受累淋巴结/切除淋巴结）为0.25。最高肿瘤分级为G1（61%的患者）和G2（37%的患者）。107例患者中，13例（12%）有局部淋巴结复发。5年无淋巴结复发生存率为88%。中位总生存（OS）时间为128个月（范围为91至165个月）。多因素分析中，高嗜铬粒蛋白A（CgA）水平和腹膜癌转移与较短的OS显著相关。
对整个小肠进行系统触诊比术前影像学检查能发现更多的多发神经内分泌肿瘤。广泛切除淋巴结的系统性手术与低局部复发率相关。高CgA水平和癌转移与较短的生存期相关。
