Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2024

02-01-2024 | Neuroendocrine Tumor | Gastrointestinal Oncology

ASO Practice Guidelines Series: Surgical Management of Gastrointestinal (Midgut) Neuroendocrine Neoplasms

Authors: Julie Hallet, MD, MSc, Callisia N. Clarke, MD, MS

Published in: Annals of Surgical Oncology | Issue 3/2024

Login to get access

Abstract

Gastrointestinal midgut neuroendocrine neoplasms (NENs) are a heterogeneous group of uncommon malignancies. For well-differentiated NENs, known as neuroendocrine tumors (NETs), surgery is a cornerstone of management in localized and metastatic disease. Because of heterogeneous tumor behaviour, association with endocrine syndrome, and prognosis, the management of NETs must be individualized to all these factors in addition to the primary site. With the fast pace of advancement in the field, both for therapies and understanding of tumoral etiology and behaviour, it is important for surgical oncologists to remain updated on guidelines recommendations and suggested treatment pathways. Those guidelines provide important guidance for management of NETs but are largely based on expert opinions and interpretation of retrospective evidence. This article reviews highlights of most recent practice guidelines for midgut (gastric, duodenal, small intestinal, and appendiceal) NETs.
Literature
1.
Hallet J, Cukier M, Saskin R, Liu N. Exploring the rising incidence of neuroendocrine tumors: a population-based analysis of epidemiology, metastatic presentation, and outcomes. Cancer. 2015;121(4):589–97.PubMedCrossRef
2.
Dasari A, Shen C, Halperin D, et al. Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol. 2017;3(10):1335–8.PubMedPubMedCentralCrossRef
3.
Modlin IM, Oberg K, Chung DC, et al. Gastroenteropancreatic neuroendocrine tumours. Lancet Oncol. 2008;9(1):61–72.PubMedCrossRef
4.
5.
6.
7.
Laskaratos F-M, Rombouts K, Caplin M, Toumpanakis C, Thirlwell C, Mandair D. Neuroendocrine tumors and fibrosis: An unsolved mystery? Cancer. 2017;123(24):4770–90.PubMedCrossRef
8.
Laskaratos FM, Diamantopoulos L, Walker M, et al. Prognostic factors for survival among patients with small bowel neuroendocrine tumours associated with mesenteric desmoplasia. Neuroendocrinology. 2018;106(4):366–80.PubMedCrossRef
9.
Rindi G, Mete O, Uccella S, et al. Overview of the 2022 WHO classification of neuroendocrine neoplasms. Endocr Pathol. 2022;33(1):115–54.PubMedCrossRef
10.
11.
Strosberg JR, Halfdanarson TR, Bellizzi AM, et al. The north American neuroendocrine tumor society consensus guidelines for surveillance and medical management of midgut neuroendocrine tumors. Pancreas. 2017;46(6):707–14.PubMedPubMedCentralCrossRef
12.
Howe JR, Cardona K, Fraker DL, et al. The surgical management of small bowel neuroendocrine tumors: Consensus guidelines of the North American Neuroendocrine Tumor Society. Pancreas. 2017;46(6):715–31.PubMedPubMedCentralCrossRef
13.
Pavel M, Öberg K, Falconi M, et al. Gastroenteropancreatic neuroendocrine neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020;31(7):844–60.PubMedCrossRef
14.
Panzuto F, Ramage J, Pritchard DM, et al. European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for gastroduodenal neuroendocrine tumours (NETs) G1–G3. J Neuroendocrinol. 2023;35(8):e13306.PubMedCrossRef
15.
Rinke A, Ambrosini V, Dromain C, et al. European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for colorectal neuroendocrine tumours. J Neuroendocrinol. 2023;35(6):e13309.PubMedCrossRef
16.
Shah MH, Goldner WS, Benson AB, et al. Neuroendocrine and adrenal tumors, version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021;19(7):839–68.
17.
Singh S, Moody L, Chan DL, et al. Follow-up recommendations for completely resected gastroenteropancreatic neuroendocrine tumors. JAMA Oncol. 2018;4(11):1597–604.PubMedCrossRef
18.
Tsolakis AV, Ragkousi A, Vujasinovic M, Kaltsas G, Daskalakis K. Gastric neuroendocrine neoplasms type 1: a systematic review and meta-analysis. World J Gastroenterol. 2019;25(35):5376–87.PubMedPubMedCentralCrossRef
19.
Howe JR, Merchant NB, Conrad C, et al. The North American Neuroendocrine Tumor Society consensus paper on the surgical management of pancreatic neuroendocrine tumors. Pancreas. 2020;49(1):1–33.PubMedPubMedCentralCrossRef
20.
Oberg K, Couvelard A, Delle Fave G, et al. ENETS consensus guidelines for standard of care in neuroendocrine tumours: Biochemical markers. Neuroendocrinology. 2017;105(3):201–11.PubMedCrossRef
21.
Fossmark R, Jianu CS, Martinsen TC, Qvigstad G, Syversen U, Waldum HL. Serum gastrin and chromogranin A levels in patients with fundic gland polyps caused by long-term proton-pump inhibition. Scand J Gastroenterol. 2008;43(1):20–4.PubMedCrossRef
22.
Esposito G, Cazzato M, Rinzivillo M, et al. Management of type-I gastric neuroendocrine neoplasms: A 10-years prospective single centre study. Dig Liver Dis. 2022;54(7):890–5.PubMedCrossRef
23.
Mandair D, Kamieniarz L, Pizanias M, et al. Diagnostic features and management options for duodenal neuroendocrine neoplasms: a retrospective, multi-centre study. Sci Rep. 2022;12(1):15762.ADSPubMedPubMedCentralCrossRef
24.
Exarchou K, Howes N, Pritchard DM. Systematic review: management of localised low-grade upper gastrointestinal neuroendocrine tumours. Aliment Pharmacol Ther. 2020;51(12):1247–67.PubMedCrossRef
25.
Niederle B, Pape UF, Costa F, et al. ENETS consensus guidelines update for neuroendocrine neoplasms of the jejunum and ileum. Neuroendocrinology. 2016;103(2):125–38.PubMedCrossRef
26.
27.
Partelli S, Bartsch DK, Capdevila J, et al. ENETS consensus guidelines for standard of care in neuroendocrine tumours: surgery for small intestinal and pancreatic neuroendocrine tumours. Neuroendocrinology. 2017;105(3):255–65.PubMedCrossRef
28.
Öhrvall U, Eriksson B, Juhlin C, et al. Method for dissection of mesenteric metastases in mid-gut carcinoid tumors. World J Surg. 2014;24(11):1402–8.CrossRef
29.
Ohrvall U, Eriksson B, Juhlin C, et al. Method for dissection of mesenteric metastases in mid-gut carcinoid tumors. World J Surg. 2000;24(11):1402–8.PubMedCrossRef
30.
Hallet J, Law C, Commonwealth Neuroendocrine Tumours Research Collaborative (CommNETs) Surgical Section. Extent of lymph node dissection for small bowel neuroendocrine tumors. World J Surg. 2021;45(1):197–202.PubMedCrossRef
31.
Bennett S, Coburn N, Law C, et al. Upfront small bowel resection for small bowel neuroendocrine tumors with synchronous metastases. Ann Surg. 2022;276(5):e450–8.PubMedCrossRef
32.
Hellman P, Lundström T, Öhrvall U, et al. Effect of surgery on the outcome of midgut carcinoid disease with lymph node and liver metastases. World J Surg. 2002;26:991–7.PubMedCrossRef
33.
Toumpanakis C, Fazio N, Tiensuu Janson E, et al. Unmet needs in appendiceal neuroendocrine neoplasms. Neuroendocrinology. 2019;108(1):37–44.PubMedCrossRef
34.
Ribeiro S, De Maeyer F, De Man M, et al. Lessons learned about appendiceal neuroendocrine neoplasms from data analysis of the Belgian Cancer Registry 2010–2015. Acta Gastroenterol Belg. 2021;84(3):458–66.PubMedCrossRef
35.
Holmager P, Willemoe GL, Nielsen K, et al. Neuroendocrine neoplasms of the appendix: characterization of 335 patients referred to the Copenhagen NET Center of Excellence. Eur J Surg Oncol. 2021;47(6):1357–63.PubMedCrossRef
36.
Boudreaux JP, Klimstra DS, Hassan MM, et al. The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the jejunum, ileum, appendix, and cecum. Pancreas. 2010;39(6):753–66.PubMedCrossRef
37.
Brighi N, La Rosa S, Rossi G, et al. Morphological factors related to nodal metastases in neuroendocrine tumors of the appendix. Ann Surg. 2020;271(3):527–33.PubMedCrossRef
38.
Daskalakis K, Alexandraki K, Kassi E, et al. The risk of lymph node metastases and their impact on survival in patients with appendiceal neuroendocrine neoplasms: a systematic review and meta-analysis of adult and paediatric patients. Endocrine. 2020;67(1):20–34.PubMedCrossRef
39.
Galanopoulos M, McFadyen R, Drami I, et al. Challenging the current risk factors of appendiceal neuroendocrine neoplasms: Can they accurately predict local lymph nodal invasion? Results from a large case series. Neuroendocrinology. 2019;109(2):179–86.PubMedCrossRef
40.
Pavel M, Baudin E, Couvelard A, et al. ENETS Consensus Guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut, midgut, hindgut, and unknown primary. Neuroendocrinology. 2012;95(2):157–76.PubMedCrossRef
41.
Fossmark R, Balto TM, Martinsen TC, et al. Hepatic micrometastases outside macrometastases are present in all patients with ileal neuroendocrine primary tumour at the time of liver resection. Scand J Gastroenterol. 2019;54(8):1003–7.PubMedCrossRef
42.
Elias D, Lefèvre JH, Duvillard P, et al. Hepatic metastases from neuroendocrine tumors with a “thin slice” pathological examination. Ann Surg. 2010;251(2):307–10.PubMedCrossRef
43.
Scott AT, Breheny PJ, Keck KJ, et al. Effective cytoreduction can be achieved in patients with numerous neuroendocrine tumor liver metastases (NETLMs). Surgery. 2019;165(1):166–75.PubMedCrossRef
44.
Nadler A, Cukier M, Milot L, Singh S, Law C. Hepatic parenchymal preserving technique in the management of diffuse bilateral neuroendocrine tumour liver metastases: a feasible approach. Can J Surg. 2014;57(2):E2-8.PubMedPubMedCentralCrossRef
45.
Norlén O, Stålberg P, Öberg K, et al. Long-term results of surgery for small intestinal neuroendocrine tumors at a tertiary referral center. World J Surg. 2012;36(6):1419–31.PubMedCrossRef
46.
Metadata
Title
ASO Practice Guidelines Series: Surgical Management of Gastrointestinal (Midgut) Neuroendocrine Neoplasms
Authors
Julie Hallet, MD, MSc
Callisia N. Clarke, MD, MS
Publication date
02-01-2024
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 3/2024
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-14802-8

Other articles of this Issue 3/2024

Annals of Surgical Oncology 3/2024 Go to the issue

ASO Visual Abstract

ASO Visual Abstract: Quality of Life After Extended Pelvic Surgery with Neurovascular or Bony Resections in Gynecological Oncology: A Systematic Review

ASO Visual Abstract

ASO Visual Abstract: Actual 5-Year Survival After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Patients with Peritoneal Carcinomatosis of Colorectal Origin

ASO Visual Abstract

ASO Visual Abstract: Expanding Access to Immediate Lymphatic Reconstruction through an Axillary Surgery Referral Program—Six-Year Single Center Experience

Breast Oncology

De-Escalation of Multidisciplinary Breast Cancer Care with Cryoablation Therapy: Navigating Novel Therapeutics, Ethics, and Outcomes

ASO Author Reflections

ASO Author Reflections: Simplifying the Fundamentals of Gastric Neuroendocrine Tumor Management

ASO Author Reflections

ASO Author Reflections: Association Between Historical Redlining and Access to High-Volume Hospitals Among Patients Undergoing Complex Cancer Surgery in California