Unit of General and Hepatobiliary Surgery, University Hospital "G.B. Rossi", Piazzale "L. Scuro" 10, 37134, Verona, Italy.
Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, General and Hepatobiliary Surgery Unit, ENETS Center of Excellence, Verona University, Verona, Italy.
J Gastrointest Surg. 2021 Jan;25(1):333-336. doi: 10.1007/s11605-020-04682-8. Epub 2020 Aug 3.
Since lymphadenectomy is crucial in midgut neuroendocrine tumor (NET) surgery, we adopted laparoscopic CME right hemicolectomy (LRH-CME) for the treatment of right colon and terminal ileum NETs. In this report, we present a series of nine cases of terminal midgut NETs (TM-NETs) treated by LRH-CME with a video demonstrating oncological principles and the surgical technique.
From September 2014 to November 2019, nine patients affected by TM-NETs underwent LRH-CME at the Unit of General and Hepatobiliary Surgery, University of Verona Hospital Trust, ENETS Center of Excellence. Clinicopathological data, post-operative and oncological outcomes were prospectively collected and analyzed.
Tumors were in ileocecal valve or terminal ileum (5 cases), right colon (3 cases), and appendix (one case). Surgery had a curative intent (R0 resection) in 7 cases. Surgical debulking was required in 2 metastatic cases. Mean surgical time was 212 + 41 min and blood loss 47 + 24 mL. No postoperative mortality was observed. Post-operative course was uneventful in all except one case (Clavien-Dindo III). Median number of harvested lymph nodes was 21 (range, 11-31) and eight out of 9 patients were node positive (median 3, range 0-6). At a median follow-up of 18 months (range, 6-50), none of the patients suffered from mesenteric locoregional recurrence and all R0 resected patients were disease-free.
Terminal midgut NETs represent an optimal indication for LRH-CME which increases the chance of complete resection and allows optimal lymphadenectomy. In expert hands, laparoscopic approach should be favored in consideration of good short-term outcomes.
由于淋巴结切除术在中肠神经内分泌肿瘤（NET）手术中至关重要，我们采用腹腔镜右半结肠切除术（LRH-CME）治疗右半结肠和末端回肠 NET。在本报告中，我们展示了一组 9 例末端中肠 NET（TM-NET）患者接受 LRH-CME 治疗的病例，其中包括一段视频，演示了肿瘤学原则和手术技术。
自 2014 年 9 月至 2019 年 11 月，9 例 TM-NET 患者在意大利维罗纳大学医院信托基金的普通和肝胆外科接受了 LRH-CME 治疗，该医院是 ENETS 卓越中心。前瞻性收集并分析了临床病理数据、术后和肿瘤学结果。
肿瘤位于回盲瓣或末端回肠（5 例）、右半结肠（3 例）和阑尾（1 例）。7 例手术具有治愈性（R0 切除）。2 例转移性病例需要进行手术减瘤。手术时间平均为 212+41 分钟，失血量为 47+24 毫升。无术后死亡。除 1 例（Clavien-Dindo III 级）外，所有患者术后过程均无异常。切除的淋巴结中位数为 21 个（范围为 11-31 个），9 例中有 8 例淋巴结阳性（中位数为 3 个，范围为 0-6 个）。在中位随访 18 个月（范围为 6-50 个月）期间，无患者发生肠系膜局部复发，所有 R0 切除患者均无疾病。
TM-NET 是 LRH-CME 的理想适应证，可增加完全切除的机会，并允许进行最佳的淋巴结清扫。在有经验的医生手中，应考虑到良好的短期结果，优先采用腹腔镜方法。
