Kenney Lisa M, Hughes Marybeth
Department of Surgery, Eastern Virginia Medical School, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, 825 Fairfax Avenue, Suite 610, Norfolk, VA 23507, USA.
Department of Surgery, Division of Surgical Oncology, Eastern Virginia Medical School, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, 825 Fairfax Avenue, Suite 610, Norfolk, VA 23507, USA.
Cancers (Basel). 2025 Jan 23;17(3):377. doi: 10.3390/cancers17030377.
BACKGROUND/OBJECTIVES: Neuroendocrine tumors (NETs) are heterogeneous malignancies arising from enterochromaffin cells that can arise from the gastrointestinal (GI) tract and pancreas. Surgical management is the cornerstone of treatment, with the optimal approach tailored by tumor grade, size, location, and presence of metastasis. This review discusses the current strategies for the surgical management of NETs of the gastroenteropancreatic tract.
A review of the available literature was conducted to evaluate surgical approaches to NETs. Consensus guidelines were incorporated to synthesize evidence-based recommendations.
For gastric NETs, surgical approach depends on Rindi Classification, WHO grade, and tumor size, with endoscopic approaches favored for smaller and low-grade lesions. Small bowel NETs can be multifocal and thus often require a surgical approach with careful evaluation of the entire intestine. Pancreatic NETs are categorized as functional or non-functional, with enucleation or formal resection strategies based on size, location, functional status, and risk of malignancy. Colorectal NETs are primarily treated with transanal localized or formal surgical resection, depending on lesion size and depth of invasion or presence of lymph node involvement. Appendiceal NETs are either treated with appendectomy or right hemicolectomy, depending on the size, location, and invasiveness of the lesions. For metastatic NETs, cytoreduction, liver transplantation, and targeted therapies offer symptom relief and possible survival benefits.
Surgical resection provides curative potential for localized NETs and symptom control in metastatic cases. Future research is essential to refine guidelines for intermediate-risk lesions and multifocal tumors, ensuring optimal outcomes for patients with gastroenteropancreatic NETs.
背景/目的：神经内分泌肿瘤（NETs）是起源于肠嗜铬细胞的异质性恶性肿瘤，可发生于胃肠道（GI）和胰腺。手术治疗是治疗的基石，最佳治疗方法根据肿瘤分级、大小、位置和转移情况进行调整。本文综述了胃肠道胰腺神经内分泌肿瘤手术治疗的当前策略。
对现有文献进行综述，以评估神经内分泌肿瘤的手术方法。纳入共识指南以综合基于证据的建议。
对于胃神经内分泌肿瘤，手术方法取决于林迪分类、世界卫生组织分级和肿瘤大小，较小的低级别病变更倾向于内镜治疗。小肠神经内分泌肿瘤可能为多灶性，因此通常需要手术治疗并仔细评估整个肠道。胰腺神经内分泌肿瘤分为功能性或非功能性，根据大小、位置、功能状态和恶性风险采用剜除术或正规切除术。结直肠神经内分泌肿瘤主要根据病变大小、浸润深度或淋巴结受累情况采用经肛门局部切除或正规手术切除。阑尾神经内分泌肿瘤根据病变大小、位置和侵袭性采用阑尾切除术或右半结肠切除术。对于转移性神经内分泌肿瘤，减瘤手术、肝移植和靶向治疗可缓解症状并可能带来生存益处。
手术切除为局限性神经内分泌肿瘤提供了治愈潜力，并可控制转移性病例的症状。未来的研究对于完善中危病变和多灶性肿瘤的指南至关重要，以确保胃肠道胰腺神经内分泌肿瘤患者获得最佳治疗效果。
