Surgical Management of Small Bowel Neuroendocrine Tumour Symposia

Excerpt

While rare, the incidence of small bowel neuroendocrine tumours (SBNETs) is increasing and they are now the most frequently encountered small bowel tumour [1]. Up to one quarter of SBNETs present acutely, many present as an incidentally, and most present with metastatic stage IV disease [2]. Neuroendocrine tumours usually require consultative, multidisciplinary management at specialized centres. Prolonged survival with good quality of life can be achieved in patients even with extensive metastatic disease. However, with the rising incidence and the presentation of complications from advanced disease such as obstruction, ischemia, perforation and bleeding, many of the patients with SBNET will be encountered by every general and sub-specialty surgeon undertaking acute and emergency surgery. The dilemmas that are faced by the operating surgeon who encounters this disease include: 1. How to manage of the SBNET presenting with acute complications such as obstruction and perforation? 2. The extent and technique of regional lymphadenectomy, how to do it safely? 3. What are the significance and the management of multifocal disease? 4. What is the recommended management of the primary and regional disease in patients with distant (predominately liver) metastatic disease? 5. Finally, what is the best palliation and management for the rare patients with unresectable SBNET? The following symposium attempts to answer and address these practical issues faced by the operation surgeon in patients with SBNETs. In this issue of the World Journal of Surgery, five surgeons from Canada and New Zealand present a symposia of concise reviews summarizing the management options for patients presenting with complex SBNET disease. …