Manguso Nicholas, Gangi Alexandra, Nissen Nicholas, Harit Attiya, Siegel Emily, Hendifar Andrew, Amersi Farin
Department of Surgery and †Division of Hematology and Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Am Surg. 2018 Oct 1;84(10):1570-1574.
Small bowel neuroendocrine tumors (SBNETs) are often indolent, but occasionally, patients present with acute symptoms requiring emergent operative intervention. Our aim was to determine whether emergency surgery for SBNETs affects long-term outcomes. An institutional database was reviewed to identify patients with SBNET diagnosed between 1990 and 2015. Need for emergency resection (ER) was compared with elective resection (ELR). One hundred and thirty-four patients met inclusion criteria. Median age was 59 years (range, 21-91), and median tumor size was 1.5 cm (range, 0.1-5). Median follow-up time was 5.5 years. One hundred (74.6%) patients had ELR, whereas 34 (25.4%) required ER. ELR had a higher number of lymph nodes resected (median 12.5 8 ER, = 0.04); however, there was no difference in the number of positive nodes (median 3 2, = 0.85). There were 45 (33.6%) recurrences (31 [31.0%] ELR 14 [41.7%] ER, = 0.29) and 13 (9.7%) deaths (7 [7.0%] ELR; 6 [17.6%] ER). There was no significant difference in 5-year disease-free survival (ELR 72.6% ER 77.9%, = 0.71) or overall survival (ELR 97.2% ER 96.6%, = 0.81). Although patients undergoing ER have significantly fewer lymph nodes resected, they have comparable recurrence rates and long-term outcomes with those patients undergoing ER.
小肠神经内分泌肿瘤（SBNETs）通常发展缓慢，但偶尔患者会出现需要紧急手术干预的急性症状。我们的目的是确定SBNETs的急诊手术是否会影响长期预后。回顾了一个机构数据库，以识别1990年至2015年间诊断为SBNETs的患者。将急诊切除术（ER）与择期切除术（ELR）进行比较。134例患者符合纳入标准。中位年龄为59岁（范围21 - 91岁），中位肿瘤大小为1.5厘米（范围0.1 - 5厘米）。中位随访时间为5.5年。100例（74.6%）患者接受了ELR，而34例（25.4%）需要ER。ELR切除的淋巴结数量更多（中位数12.5对ER为8，P = 0.04）；然而，阳性淋巴结数量没有差异（中位数3对2，P = 0.85）。有45例（33.6%）复发（ELR组31例[31.0%]对ER组14例[41.7%]，P = 0.29），13例（9.7%）死亡（ELR组7例[7.0%]；ER组6例[17.6%]）。5年无病生存率（ELR组72.6%对ER组77.9%，P = 0.71）或总生存率（ELR组97.2%对ER组96.6%，P = 0.81）没有显著差异。尽管接受ER的患者切除的淋巴结明显较少，但他们与接受ELR的患者具有可比的复发率和长期预后。
