Background/Objectives: Neuroendocrine tumors (NETs) are heterogeneous malignancies arising from enterochromaffin cells that can arise from the gastrointestinal (GI) tract and pancreas. Surgical management is the cornerstone of treatment, with the optimal approach tailored by tumor grade, size, location, and presence of metastasis. This review discusses the current strategies for the surgical management of NETs of the gastroenteropancreatic tract. Methods: A review of the available literature was conducted to evaluate surgical approaches to NETs. Consensus guidelines were incorporated to synthesize evidence-based recommendations. Results: For gastric NETs, surgical approach depends on Rindi Classification, WHO grade, and tumor size, with endoscopic approaches favored for smaller and low-grade lesions. Small bowel NETs can be multifocal and thus often require a surgical approach with careful evaluation of the entire intestine. Pancreatic NETs are categorized as functional or non-functional, with enucleation or formal resection strategies based on size, location, functional status, and risk of malignancy. Colorectal NETs are primarily treated with transanal localized or formal surgical resection, depending on lesion size and depth of invasion or presence of lymph node involvement. Appendiceal NETs are either treated with appendectomy or right hemicolectomy, depending on the size, location, and invasiveness of the lesions. For metastatic NETs, cytoreduction, liver transplantation, and targeted therapies offer symptom relief and possible survival benefits. Conclusions: Surgical resection provides curative potential for localized NETs and symptom control in metastatic cases. Future research is essential to refine guidelines for intermediate-risk lesions and multifocal tumors, ensuring optimal outcomes for patients with gastroenteropancreatic NETs.
背景/目的：神经内分泌肿瘤（NETs）是一类起源于肠嗜铬细胞的异质性恶性肿瘤，可发生于胃肠道和胰腺。手术治疗是其核心治疗手段，最佳方案需根据肿瘤分级、大小、位置及是否存在转移进行个体化制定。本综述探讨当前胃肠胰神经内分泌肿瘤的外科治疗策略。方法：通过回顾现有文献评估神经内分泌肿瘤的手术方法，并结合共识指南整合循证医学建议。结果：胃神经内分泌肿瘤的手术方式取决于Rindi分型、WHO分级及肿瘤大小，较小且低级别的病变倾向于内镜下切除。小肠神经内分泌肿瘤常呈多灶性，通常需手术切除并仔细评估整个肠道。胰腺神经内分泌肿瘤分为功能性和非功能性两类，根据肿瘤大小、位置、功能状态及恶性风险选择剜除术或规范切除术。结直肠神经内分泌肿瘤主要采用经肛门局部切除或规范外科切除术，具体取决于病灶大小、浸润深度及淋巴结转移情况。阑尾神经内分泌肿瘤根据病灶大小、位置及侵袭性选择阑尾切除术或右半结肠切除术。对于转移性神经内分泌肿瘤，减瘤手术、肝移植及靶向治疗可缓解症状并可能带来生存获益。结论：手术切除对局限性神经内分泌肿瘤具有治愈潜力，对转移性病例可有效控制症状。未来需进一步研究以完善中危病变和多灶性肿瘤的治疗指南，确保胃肠胰神经内分泌肿瘤患者获得最佳临床结局。
Surgical Management of Gastroenteropancreatic Neuroendocrine Tumors
肿瘤(癌症)患者之家