Bartsch Detlef K, Krasser-Gercke Norman, Jesinghaus Moritz, Görlach Jannis, Eilsberger Frederike, Rinke Anja, Maurer Elisabeth
Department of Visceral-, Thoracic- and Vascular Surgery, Philipps-University Marburg, Marburg, Germany.
Institute of Pathology, Philipps-University Marburg, Marburg, Germany.
World J Surg. 2025 May;49(5):1343-1350. doi: 10.1002/wjs.12582. Epub 2025 Apr 16.
Complete resection is the only chance for cure in small intestine neuroendocrine neoplasms (SI-NEN). Previous ENETS guidelines proposed standards for the surgery of SI-NEN, which should be followed to provide long-term disease-free survival.
To analyze the results of reintervention for locoregional SI-NEN (stages I-III) after suboptimal initial resection.
Perioperative characteristics of all patients who underwent surgical reintervention after suboptimal initial resection (SIR) of locoregional SI-NEN were retrieved from a prospective database. Patient characteristics, initial and redo procedures, imaging before reintervention, pathological results of SIR, and after reintervention, including missed primary tumors and lymph node metastases, were retrospectively analyzed.
During a 15 years period, 21 of 93 (22%) patients had surgical reinterventions after SIR. In 20 of 21 (95%) cases, the initial resection was performed outside an ENETS center of excellence. Ten (48%) of those cases were emergency operations because of the bowel obstruction or bowel bleeding. Seven SIR (33%) cases were performed laparoscopically, and in another 5 (24%) cases, a complete endoscopic mucosa resection was performed. Imaging before reintervention visualized residual disease in 15 of 21 (71%) patients. Surgical reintervention included either lymphadenectomy alone (LAD, n = 3) or small bowel resection plus systematic LAD (n = 12) or right hemicolectomy/ileocecal resection with systematic LAD (n = 6), respectively. In 19 of 21 (90%) patients, a R0 resection could be achieved. One patient (5%) experienced postoperative clinically relevant complications. According to pathology, in 10 (48%) patients lymph node metastases, in 6 (29%) patients additional primary tumors, and in 5 (24%) patients, both lymph nodes metastases and primary tumors were left behind in the SIR. After mean follow-up of 52 months, 16 (76%) of 21 patients were free of disease, 4 (19%) patients were alive with disease, and 1 patient deceased of an unrelated cause.
The proposed standards to resect locoregional SI-NEN should be followed to avoid SIR, although the prognosis after adequate surgical reintervention is good.
完整切除是小肠神经内分泌肿瘤（SI-NEN）唯一的治愈机会。先前的欧洲神经内分泌肿瘤学会（ENETS）指南提出了SI-NEN的手术标准，应遵循这些标准以实现长期无病生存。
分析局部区域SI-NEN（I-III期）初次切除不充分后再次干预的结果。
从一个前瞻性数据库中检索所有在局部区域SI-NEN初次切除不充分（SIR）后接受手术再次干预的患者的围手术期特征。回顾性分析患者特征、初次和再次手术操作、再次干预前的影像学检查、SIR的病理结果以及再次干预后的病理结果，包括遗漏的原发性肿瘤和淋巴结转移情况。
在15年期间，93例患者中有21例（22%）在SIR后接受了手术再次干预。在21例中的20例（95%）病例中，初次切除是在ENETS卓越中心以外进行的。其中10例（48%）病例是由于肠梗阻或肠出血而进行的急诊手术。7例SIR（33%）病例通过腹腔镜进行，另外5例（24%）病例进行了完整的内镜黏膜切除术。再次干预前的影像学检查显示21例患者中有15例（71%）存在残留病灶。手术再次干预分别包括单纯淋巴结清扫（LAD，n = 3）、小肠切除加系统性LAD（n = 12）或右半结肠切除/回盲部切除加系统性LAD（n = 6）。21例患者中有19例（90%）可实现R0切除。1例患者（5%）出现术后临床相关并发症。根据病理结果，10例（48%）患者有淋巴结转移，6例（29%）患者有额外的原发性肿瘤，5例（24%）患者在SIR中同时遗留了淋巴结转移和原发性肿瘤。平均随访52个月后，21例患者中有16例（76%）无疾病，4例（19%）患者带瘤生存，1例患者因无关原因死亡。
应遵循提议的局部区域SI-NEN切除标准以避免SIR，尽管充分的手术再次干预后的预后良好。
