Survival Outcomes in Stage IV Small Bowel Neuroendocrine Tumor Patients Undergoing Loco-Regional Surgery: An Experience From a Pakistani Cancer Center.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.