Abstract
AimOpen resection of small bowel neuroendocrine neoplasms (SB-NEN) is still considered standard-of-care, mainly because of frequently encountered multifocality and central mesenteric masses. The aim of this study was to evaluate surgical approach for SB-NEN at a national level and determine predictors for overall survival.MethodsPatients with SB-NEN who underwent resection between 2005 and 2015 were included from the Netherlands Cancer Registry. Patient and tumor characteristics were compared between laparoscopic and open approach. Overall survival was assessed by Kaplan–Meier and compared with the Log-rank test. Independent predictors were determined by Cox proportional hazards model.ResultsIn total, 482 patients were included, of whom 342 (71%) underwent open and 140 (29%) laparoscopic resection. The open resection group had significantly more multifocal tumors resected (24% vs. 14%), pN2 lymph nodes (18% vs. 7%) and stage IV disease (36% vs. 22%). Overall survival after open resection was significantly shorter compared to laparoscopic resection (3-year: 81% vs. 89%, 5-year: 71% vs. 84%, p = 0.004). In multivariable analysis, age above 60-years (60–75, HR 3.38 (95% CI 1.84–6.23); > 75 years, HR 7.63 (95% CI 3.86–15.07)), stage IV disease (HR 1.86 (95% CI 1.18–2.94)) and a laparoscopic approach (HR 0.51 (95% CI 0.28–0.94)) were independently associated with overall survival, whereas multifocal primary tumor, grade and resection margin status were not.ConclusionLaparoscopic resection was the approach in 29% of SB-NEN at a national level with selection of the more favorable patients. Laparoscopic resection remained independently associated with better overall survival besides age and stage, but residual confounding cannot be excluded.
Highlights
Small bowel neuroendocrine neoplasms (SB-NEN) are a rare type of gastrointestinal cancer and constitute 15% of all neoplasms of the jejunum and approximately 60% of the ileum, making it the most common gastroenteropancreatic NEN [1, 2]
Laparoscopic resection was the approach in 29% of small bowel neuroendocrine neoplasms (SB-NEN) at a national level with selection of the more favorable patients
Laparoscopic resection remained independently associated with better overall survival besides age and stage, but residual confounding cannot be excluded
Summary
Small bowel neuroendocrine neoplasms (SB-NEN) are a rare type of gastrointestinal cancer and constitute 15% of all neoplasms of the jejunum and approximately 60% of the ileum, making it the most common gastroenteropancreatic NEN [1, 2]. Patients with stage I-III disease are amenable for curative resection, as well as selected stage IV patients with liver metastases [3, 4]. Resection remains the main treatment modality for these patients, resulting in relatively high 5-year overall survival rates of 70–80% for stage I-III and 35–80% for stage IV disease [3]. The majority of patients with SB-NEN already present with mesenteric lymph node metastases, and multifocal primary tumors can be found in up to 25–44% [5]. These disease characteristics make SB-NEN resection challenging. Guidelines advise laparoscopic resection only in patients in which an appropriate intraoperative assessment of the bowel with proper segmental resection and adequate lymphadenectomy can be performed [3, 5]
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