Watzka F M, Fottner C, Miederer M, Weber M M, Schad A, Lang H, Musholt T J
Clinic of General, Visceral- and Transplantation Surgery, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
Endocrinology and Metabolic Diseases, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
World J Surg. 2016 Mar;40(3):749-58. doi: 10.1007/s00268-016-3432-2.
Neuroendocrine Neoplasms of the small intestine have been noticed more frequently over the past 35 years. They constitute about 25% of all NENs and 29% of all tumors of the small intestine. Due to the predominantly indolent nature and overall good prognosis, the benefit of surgical treatment is still debated.
In a retrospective study, data of 83 surgically treated patients with neuroendocrine neoplasms of the small intestine, 48 males and 35 females with a median age of 62 years (range 25-86 years) were analyzed. Patient data were documented in the MaDoc database for neuroendocrine tumors of the University Medical Center of Mainz. IBM SPSS Statistics 20 was used for statistical analysis. Kaplan-Meier survival curves and Log-Rank tests, censoring patients at the time of last follow-up, were used to compare the overall survival depending on potential prognostic factors (stage, grade, surgical treatment).
At the time of diagnoses, the most common clinical symptoms were abdominal pain (n = 31, 37.3%), bowel obstruction (n = 11, 13.3%), bowel perforation and peritonitis (n = 3, 3.6%), gastrointestinal bleeding (n = 9, 10.8%), weight loss (n = 11, 13.3%), and carcinoid syndrome (n = 27, 32.5%). 65 patients (78.3%) had lymph node metastasis and in 58 patients (69.9%) distant metastasis were present. Segmental bowel resection (44) was the most common surgical procedure, followed by right hemi-colectomy (32) and explorative laparotomy (7). In most patients (78.9%), lymphadenectomy (systematic/selective) was performed. The 5-year survival of patients who underwent a systematic or a selective lymphadenectomy differed significantly (82.2 vs. 40.0%). The overall 3-, 5-, and 10-year survival rates were 88.2, 80.3, and 71.0%, respectively.
Mesenteric lymph node metastases are almost invariably present and have significant impact on patients' prognosis. Systematic lymphadenectomy prevents complications and improves the survival. Early surgical treatment should be the goal in order to prevent complications.
在过去35年中，小肠神经内分泌肿瘤的发现频率更高。它们约占所有神经内分泌肿瘤的25%，占小肠所有肿瘤的29%。由于其主要为惰性性质且总体预后良好，手术治疗的益处仍存在争议。
在一项回顾性研究中，分析了83例接受手术治疗的小肠神经内分泌肿瘤患者的数据，其中48例男性和35例女性，中位年龄为62岁（范围25 - 86岁）。患者数据记录在美因茨大学医学中心神经内分泌肿瘤的MaDoc数据库中。使用IBM SPSS Statistics 20进行统计分析。采用Kaplan-Meier生存曲线和Log-Rank检验，在最后一次随访时对患者进行截尾，以根据潜在的预后因素（分期、分级、手术治疗）比较总生存率。
在诊断时，最常见的临床症状为腹痛（n = 31，37.3%）、肠梗阻（n = 11，13.3%）、肠穿孔和腹膜炎（n = 3，3.6%）、胃肠道出血（n = 9，10.8%）、体重减轻（n = 11，13.3%）和类癌综合征（n = 27，32.5%）。65例患者（78.3%）有淋巴结转移，58例患者（69.9%）有远处转移。节段性肠切除（44例）是最常见的手术方式，其次是右半结肠切除（32例）和探查性剖腹术（7例）。大多数患者（78.9%）进行了淋巴结清扫（系统性/选择性）。接受系统性或选择性淋巴结清扫的患者5年生存率有显著差异（82.2%对40.0%）。总体3年、5年和10年生存率分别为88.2%、80.3%和71.0%。
肠系膜淋巴结转移几乎总是存在，对患者预后有重大影响。系统性淋巴结清扫可预防并发症并提高生存率。早期手术治疗应作为预防并发症的目标。
