Background: Approximately 10% of patients with small intestine neuroendocrine neoplasms (SI-NENs) present with locally advanced, unresectable symptomatic disease. The present study analyzed the results of debulking of the mesenteric mass in such patients. Methods: Patients operated on for locally advanced SI-NEN disease were identified from the prospective database of the ENETS Center of Excellence Marburg based on the review of imaging results and operative notes. “Locally advanced” was defined as mesenteric disease involving the mesenteric root above the level of the horizontal part of the duodenum and/or extending into the retroperitoneum. Patient characteristics, operations, and outcomes were retrospectively analyzed. Results: 29 of 202 (14%) operated SI-NEN patients (79% male) operated on, with a median age of 63 (46–78) years, had symptomatic locally advanced disease and presented with either abdominal pain (76%) and/or symptoms of obstruction (38%). Imaging revealed a mesenteric mass >10 mm above the level of the pars descendens duodeni in 15 (52%) patients, with tumor-related obstruction of the superior mesenteric vein in 17 (59%) patients. Fourteen (48%) patients had had previous surgery with primary tumor resection (n= 10) or diagnostic or bypass procedures (n= 4). Debulking of the mesenteric mass with (n= 26) or without (n= 2) bowel resection was performed 28 patients; the remaining patient underwent only resection of the ischemic bowel. Median operating time was 262 (156–411) minutes. Four (14%) patients had clinically relevant postoperative complications; one patient died perioperatively. A total of 27/29 (93%) patients reported improvement in preoperative abdominal symptoms. After a median follow-up of 28 (1–142) months, 21 (72%) patients were alive with disease. Conclusions: Debulking of the mesenteric mass in locally advanced symptomatic SI-NENs is a challenging procedure, but most patients benefit in terms of bowel symptoms.
背景：约10%的小肠神经内分泌肿瘤（SI-NENs）患者表现为局部晚期、无法切除的症状性疾病。本研究分析了此类患者肠系膜肿块减瘤术的治疗效果。方法：通过回顾影像学结果和手术记录，从马尔堡ENETS卓越中心的前瞻性数据库中筛选出因局部晚期SI-NEN接受手术的患者。"局部晚期"定义为肠系膜病变累及十二指肠水平部以上肠系膜根部和/或延伸至腹膜后间隙。对患者特征、手术方式和预后进行回顾性分析。结果：202例接受手术的SI-NEN患者中，29例（14%）为有症状的局部晚期疾病（男性占79%），中位年龄63岁（46-78岁）。患者主要表现为腹痛（76%）和/或梗阻症状（38%）。影像学显示15例（52%）患者十二指肠降部水平以上存在>10 mm的肠系膜肿块，17例（59%）患者出现肿瘤相关性肠系膜上静脉梗阻。14例（48%）患者既往接受过原发肿瘤切除术（n=10）或诊断性/转流手术（n=4）。28例患者接受了肠系膜肿块减瘤术（联合肠切除术26例，未联合2例），剩余1例仅行缺血肠段切除术。中位手术时间为262分钟（156-411分钟）。4例（14%）患者出现临床相关术后并发症，1例患者围手术期死亡。27/29例（93%）患者术前腹部症状得到改善。中位随访28个月（1-142个月）后，21例（72%）患者带瘤生存。结论：局部晚期有症状SI-NEN的肠系膜肿块减瘤术是具有挑战性的手术，但大多数患者在肠道症状方面可获得改善。
肿瘤(癌症)患者之家