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Prognostic Factors in Curative Resected Locoregional Small Intestine Neuroendocrine Neoplasms

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Abstract

Background

Small intestinal neuroendocrine neoplasms (SI-NEN) are rare, and only about 40% of patients are diagnosed without distant metastases. Aim of the study was to identify prognostic factors in patients with potentially curative resected locoregional SI-NEN.

Methods

Patients with curative resected locoregional SI-NEN (ENETS stages I-III) were retrieved from a prospective data base. Demographic, surgical and pathological data of patients with and without disease recurrence were retrospectively analyzed using univariate and multivariate analysis.

Results

In a 20-year period, 65 of 203 (32%) patients with SI-NEN were operated for stages I–III disease. Thirty-eight (58.5%) patients were men, and the median age at surgery was 59 (range 37–87) years. After median follow-up of 65 months, 14 patients experienced disease relapse median 28.5 (range 6–122) months after initial surgery, of which 2 died due to their disease. Multivariate analysis revealed age ≥ 60 years (HR = 6.41, 95% CI 1.38–29.67, p = 0.017), tumor size ≥ 2 cm (HR = 26.54, 95% CI 4.46–157.62, p < 0.001), lymph node ratio > 0.5 (HR 7.18, 95% CI 1.74–29.74, p = 0.007) and multifocal tumor growth (HR = 6.98, 95% CI 1.66–29.39, p = 0.008) as independent negative prognostic factors and right hemicolectomy compared to segmental small bowel resection (HR = 0.04, 95% CI 0.01–0.24, p < 0.001) as independent protector against recurrence.

Conclusion

Patients with locoregional SI-NEN with an age ≥ 60 years, tumor size ≥ 2 cm, lymph node ratio > 0.5 and multiple small bowel tumor foci have an increased risk for recurrence and might benefit from adjuvant treatment. In contrast, right hemicolectomy of ileal SI-NEN seems to reduce the risk of recurrence.

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Acknowledgements

We thank Dr. Hans-Helge Müller, Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, for his excellent statistical support.

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Authors and Affiliations

  1. Department of Visceral, Thoracic and Vascular Surgery, Philipps-University Marburg, 35043, Baldingerstrasse Marburg, Germany

    Maximilian Evers, Johannes Rütz, Elisabeth Maurer & Detlef K. Bartsch

  2. Department of Gastroenterology and Endocrinology, Philipps-University Marburg, Marburg, Germany

    Anja Rinke

  3. Department of Pathology, Philipps-University Marburg, Marburg, Germany

    Annette Ramaswamy

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  1. Maximilian Evers
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Evers, M., Rinke, A., Rütz, J. et al. Prognostic Factors in Curative Resected Locoregional Small Intestine Neuroendocrine Neoplasms. World J Surg 45, 1109–1117 (2021). https://doi.org/10.1007/s00268-020-05884-6

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