Mesenteric Fibrosis in Neuroendocrine Neoplasms: a Systematic Review of New Thoughts on Causation and Potential Treatments.

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Mesenteric fibrosis (MF) is a hallmark of small intestinal neuroendocrine neoplasms (SI-NEN) and is frequently associated with significant morbidity due to related complications such as intestinal obstruction, ischemia, and cachexia. Herein we performed a systematic review to discuss the development of MF in SI-NEN. The pathophysiological mechanisms acknowledged as causative for the development of MF include the major components of the tumor microenvironment, such as fibroblasts, endothelial and immune cells and the extracellular matrix, which are involved in a complex interplay activating several signaling pathways that promote profibrotic factors and induce both a desmoplastic reaction and tumor proliferation. Surgery remains the mainstay of treatment, while several medical management options of MF complicating SI-NEN available present rather limited efficacy. MF is a frequent characteristic of SI-NEN that requires particular attention and targeted management to avoid complications.