Annals of Surgical Oncology

, Volume 22, Supplement 3, pp 742–749 | Cite as

Surgical Management of Small Bowel Neuroendocrine Tumors: Specific Requirements and Their Impact on Staging and Prognosis

  • Arnaud Pasquer
  • Thomas Walter
  • Valérie Hervieu
  • Julien Forestier
  • Jean-Yves Scoazec
  • Catherine Lombard-Bohas
  • Gilles Poncet
Endocrine Tumors



Small bowel neuroendocrine tumors (SB-NETs) are characterized by two main features: they usually are metastatic at diagnosis and multiple in 30 % of cases. As such, SB-NETs require specific surgical management. This retrospective study examined local recurrence, survival, and prognosis of SB-NETs after adapted surgery.


All consecutive patients with SB-NETs who underwent resection of at least one primary tumor between 1 January 2000 and 1 January 2013 were analyzed. The preoperative morphologic workup, histologic classification, and metastatic lymph node (LN) ratio (LNs involved/removed) were recorded.


The study enrolled 107 patients, 35 (33 %) of whom had multiple SB-NETs (range 1–44; mean 3.1). Preoperative imaging and perioperative surgical examination missed 61 and 33 % of SB-NETs, respectively, in contrast to pathologic examination. Of the 107 patients, 43 % had carcinoid syndrome, 70 % had metastatic disease, and 90 % had LN involvement. The median number of LNs retrieved was 12 (range 1–69). The LN ratio (LNs involved/removed) was 0.25. The highest tumoral grades were G1 (in 61 % of patients) and G2 (in 37 % of patients). Of the 107 patients, 13 (12 %) had local LN recurrence. The rate of LN recurrence-free survival at 5 years was 88 %. The median overall survival (OS) time was 128 months (range 91–165 months). In the multivariate analysis, high chromogranin A (CgA) levels and peritoneal carcinomatosis were significantly associated with shorter OS.


Systematic palpation of the entire small bowel detects more multiple NETs than preoperative imaging. Systematic surgery with extensive LN resection is associated with low local recurrence. High CgA levels and carcinomatosis are linked with shorter survival.


Overall Survival Small Bowel Lymph Node Ratio Carcinoid Syndrome Video Capsule Endoscopy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

There are no conflicts of interest.


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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Arnaud Pasquer
    • 4
  • Thomas Walter
    • 1
    • 2
    • 5
  • Valérie Hervieu
    • 2
    • 3
    • 5
  • Julien Forestier
    • 1
  • Jean-Yves Scoazec
    • 2
  • Catherine Lombard-Bohas
    • 1
  • Gilles Poncet
    • 2
    • 4
    • 5
  1. 1.Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Gastroentérologie et d’oncologie digestiveLyon Cedex 03France
  2. 2.INSERM, UMR 1052, Lyon Cancer Research Center, Faculté LaennecLyon Cedex 08France
  3. 3.Hospices Civils de Lyon, Hôpital Edouard Herriot, Service Central d’Anatomie et Cytologie PathologiquesLyon Cedex 03France
  4. 4.Hospices Civils de Lyon, Hôpital Edouard Herriot, Chirurgie digestiveLyon Cedex 03France
  5. 5.Université de Lyon, Université Claude Bernard Lyon 1Villeurbanne CedexFrance

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