Surgical Approach & Techniques of Tumours Reduction E A Antoniou MD PhD Ass Prof of Gen. Sutgery & Organ Transplantation 2 nd Propaedeutic Surgical Department, University of Athens G.H.A. Laiko NET MASTERCLASS EVGENIDES FOUNDATION ATHENS, 5 July 2014
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Surgical Approach & Techniques of Tumours Reduction
E A Antoniou MD PhD Ass Prof of Gen. Sutgery & Organ Transplantation 2nd Propaedeutic Surgical Department, University of Athens G.H.A. Laiko
NET MASTERCLASS EVGENIDES FOUNDATION ATHENS, 5 July 2014
GI- Neuroendocrine Tumours (GI-NETs)
Relatively rare – complex neoplams
Presenting many clinical challenges Sporadic, multiple, component of a familial syndrome Location assessment- GI-NETs extent : crucial for
management
Yao JC, et al. Clin Oncol 2008 Diez M, et al. Annals of Gastroenterology 2013
1. Surgery in localized disease: Curative resection of the primary tumor and locoregional
lymph node metastases improved patients’ outcomes. excellent 5- and 10-year survivals of 100% in stage 1-2 Pts still favorable outcomes in stage 3 disease with 5- and 10-
year survivals of more than 95% and 80%, respectively. Surgical procedures: small intestinal resection or right
hemicolectomy. Distal pancreatectomy, Whipple, enuclation. Clearance of mesenterial / retroperitoneal LNs metastases by dissection around the mesentery, preserving the intestinal vascular supply.
GI-NETs: Surgical Approach Conclusion
2. Surgery of Metastatic disease Primary intestinal NET/regional LN metastases Resection, in PTs with
LMs: prevention of mesenteric fibrosis, SB obstruction, painful vascular encasement. Survival is prolonged in most studies (retrospective)
localised LMs, if potentially resectable, Pt can tolerate surgery.
Surgical procedures: small intestinal resection (no large ones) or right hemicolectomy.
Whipple, Distal pancreatectomy, nucleation in combination with LMs. Mandatory LNs Clearance, as frequently malignancy of pancreatic NETs Cytoreductive surgery: when metastatic disease is localized or if >70% of
tumor load is thought resectable
GI-NETs: Surgical Approach Conclusion
3. Liver Transplantation (OLTx) OLTx role for LMs from NET: recognised, still yet undefined Literature review: studies of heterogenus population, wide-range tumour
20-48% Criteria: Unresectable LMs, absence of extrahepatic metastases,
symptomatic disease refractory to medical therapy, low grade tumour with Ki-67 <2%, previous resection of primary disease, previous therapy for metastatic NET, age <50-year.