Surgical management of locally advanced digestive tract neuroendocrine neoplasm with or without liver metastasis / 中华胃肠外科杂志

ABSTRACT

Neuroendocrine tumors in the digestive tract are rare, however their incidences increased obviously for the past few years. The purpose of this paper is to elucidate the surgical management of locally advanced digestive tract neuroendocrine neoplasms(NENs) with or without liver metastasis and to discuss the present classification of gastrointestinal NENs in order to provide reference for clinicians. WHO re-classified the gastroenteropancreatic NENs in 2010, but this classification remains many questions and needs further clinical trials to answer. Up to now, radical resection of the lesions is the only cure for the gastrointestinal NENs. For resectable locally advanced gastrointestinal NENs, standard radical or extended resection should be performed according to gastrointestinal cancer. For patients who can not receive radical procedure because of unresectable primary lesions or diffuse metastases, cytoreductive operation should be considered when endocrine symptoms exist. Palliative surgery is beneficial to the improvement of bleeding or obstruction by tumor. For unresectable liver metastatic lesion and resectable primary lesion, the primary lesion should be resected. For tolerable patients with resectable liver metastatic lesion, one-stage resection involving the primary and the liver metastatic lesions should be performed. For unresectable liver metastasis, hepatic arterial chemoembolization, systematic chemotherapy, biotherapy, targeted therapy or radio frequency ablation (RFA) should be considered to control symptoms and prevent the tumor progression.