Tayyab Zain, Ahmad Taha, Zubair Muhammad, Hussain Sana, Javed Talha, Khalid Adnan, Baig Hadia Munir, Chaudhry Noor Fatima, Nasir Talha Bin, Tara Nain
Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.
General Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.
Cureus. 2025 Mar 26;17(3):e81259. doi: 10.7759/cureus.81259. eCollection 2025 Mar.
Small bowel neuroendocrine tumors (SB-NETs) are rare malignancies often diagnosed at an advanced stage due to their nonspecific symptoms. The role of loco-regional surgery in stage IV SB-NETs remains debated, particularly in lower-middle-income countries, where healthcare resources and treatment accessibility differ from high-income settings.
This retrospective study analyzed survival outcomes in stage IV SB-NET patients who underwent loco-regional resection at Shaukat Khanum Memorial Cancer Hospital & Research Centre between 2014 and 2023. Patients with one to three hepatic metastases who underwent surgical resection were included. Clinical, pathological, and survival data were reviewed. Median survival at five and ten years was assessed.
Fifteen patients met the inclusion criteria. The median age was 47 years, with abdominal pain in all 15 patients (100%). Other symptoms included weight loss in four patients (26.7%), vomiting in four patients (26.7%), and carcinoid symptoms in three patients (20%). The ileum was the most frequently affected site in seven patients (46.7%), followed by the jejunum in four patients (26.7%). Surgical resection included small bowel resection in nine patients (60%) and hepatic metastasectomy in all 15 patients (100%). Adjuvant therapy was administered to all patients. The 30-day and 90-day mortality rates were one (6.7%) and two (13.3%), respectively. The median survival was 60% at five years and 33.3% at 10 years.
These findings suggest that surgical intervention may not offer a significant survival advantage. While our findings are consistent with existing literature regarding the predominance of small bowel NETs and the role of surgery in treatment, the small sample size and single-institution nature of this study limit the generalizability of our results.
小肠神经内分泌肿瘤（SB-NETs）是罕见的恶性肿瘤，由于其症状不具特异性，常于晚期才被诊断出来。局部区域手术在IV期SB-NETs中的作用仍存在争议，尤其是在中低收入国家，这些国家的医疗资源和治疗可及性与高收入地区不同。
这项回顾性研究分析了2014年至2023年间在沙卡特·汗姆纪念癌症医院及研究中心接受局部区域切除的IV期SB-NET患者的生存结局。纳入了一至三处肝转移且接受手术切除的患者。对临床、病理和生存数据进行了回顾。评估了五年和十年的中位生存期。
15名患者符合纳入标准。中位年龄为47岁，所有15名患者（100%）均有腹痛症状。其他症状包括4名患者（26.7%）体重减轻、4名患者（26.7%）呕吐、3名患者（20%）类癌症状。回肠是最常受累部位，有7名患者（46.7%），其次是空肠，有4名患者（26.7%）。手术切除包括9名患者（60%）行小肠切除，所有15名患者（100%）行肝转移灶切除。所有患者均接受了辅助治疗。30天和90天死亡率分别为1例（6.7%）和2例（13.3%）。五年中位生存率为60%，十年为33.3%。
这些发现表明手术干预可能不会带来显著的生存优势。虽然我们的发现与现有文献中关于小肠神经内分泌肿瘤的优势及手术在治疗中的作用一致，但本研究样本量小且为单中心性质，限制了我们结果的可推广性。
