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Neuroendocrine Gut Neoplasms: Important Lessons From Uncommon Tumors

Neuroendocrine Gut Neoplasms: Important Lessons From Uncommon Tumors Abstract Objective: To review our experiences in order to high-light some important lessons learned in the treatment of patients with neuroendocrine gut neoplasms. Design: Retrospective analysis of case series of 70 patients with neuroendocrine gut neoplasms treated between 1983 and 1993. The clinical features of individual patients illustrate lessons in surgical treatment. Setting: University hospitals with tertiary care referral practice. Interventions: The main intervention was abdominal exploration in 43 patients, with resection of the primary tumor in 39 and of hepatic metastases in four. Main Outcome Measures: To describe the tumors seen and to identify major lessons learned. Results: Of 70 patients with neuroendocrine tumors treated, 31 had carcinoid tumors, 10 each had insulinomas and gastrinomas, five had vipomas, nine had nonfunctioning islet cell tumors, three had glucagonomas, and one each had somatostatinoma and a possible cholecystokinin-secreting tumor (or CCKoma). Important lessons learned include: (1) the importance of preoperative tumor localization; (2) in multiple endocrine neoplasia, type I syndrome, the tumor found may not be the one responsible for the patient's symptoms; (3) solitary sporadic tumors secreting multiple peptides may mimic multiple tumors in multiple endocrine neoplasia, type I syndrome; (4) one needs to be prepared for the unexpected, such as the carcinoid crisis; (5) resection may sometimes be necessary even with advanced local disease; and (6) selected patients may benefit from pancreaticoduodenectomy. Conclusions: These rare tumors are interesting in their clinical presentation and can be challenging in their treatment.(Arch Surg. 1994;129:965-972) References 1. Debas HT. Clinical significance of gastrointestinal hormones . Adv Surg . 1987: 21:157-188. 2. Bale AE, Norton JA, Wong EL. Allelic loss of chromosome 11 in hereditary and sporadic tumors related to familial multiple endocrine neoplasia type I . Cancer Res . 1991;51:1154-1157. 3. Wolfe MM, Jensen RT. Zollinger-Ellison syndrome: current concepts in diagnosis and management . N Engl J Med . 1987;317:1200-1209.Crossref 4. Larsson LI, Grimelias L, Hakanson R. Mixed endocrine pancreatic tumors producing several peptide hormones . Am J Pathol . 1975;79:271-278. 5. Townsend CM Jr, Thompson JC. Surgical management of tumors that produce gastrointestinal hormones . Annu Rev Med . 1985;36:111-126.Crossref 6. Makridis C, Oberg K, Juhlin C, et al. Surgical treatment of mid-gut carcinoid tumors . World J Surg . 1990;14:377-382.Crossref 7. Kvols LK, Moertel CG, O'Connell MJ. Treatment of the malignant carcinoid syndrome . N Engl J Med . 1986;315:663-666.Crossref 8. Debas HT, Gittes G. Somatostatin analogue therapy in functioning neuroendocrine gut tumors . Digestion . 1993;54( (suppl 1) ):68-71.Crossref 9. Vinayek R, Amantea MA, Maton PN, Frucht H, Gardner JD, Jensen RT. Pharmacokinetics of oral and intravenous omeprazole in patients with Zollinger-Ellison syndrome . Gastroenterology . 1991;101:138-147. 10. Sugg SL, Norton JA, Fraker DL, et al. A prospective study of intraoperative methods to diagnose and resect duodenal gastrinomas . Ann Surg . 1993;218:138-144.Crossref 11. Rosch T, Lightdale CJ, Botet JF, et al. Localization of pancreatic endocrine tumors by endoscopic ultrasonography . N Engl J Med . 1992;326:1721-1726.Crossref 12. Sheppard BC, Norton JA, Doppman JL, Maton PN, Gardiner JD, Jensen RT. Management of islet cell tumors in patients with multiple endocrine neoplasia: a prospective study . Surgery . 1989;106:1108-1117. 13. Kent RB, van Heerden JA, Weiland LH. Non-functioning islet cell tumors . Ann Surg . 1981;193:185-190.Crossref 14. Norton JA, Sugerbaker PH, Doppman JL, et al. Aggressive resection of metastatic disease in selected patients with malignant gastrinoma . Ann Surg . 1986; 203:352-359.Crossref 15. Kvols LK, Brown ML, O'Connell MJ. Evaluation of the radiolabelled somatostatin analog (123I-octreotide) in the detection and localization of carcinoid and islet cell tumors . Radiology . 1993;187:129-133.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Neuroendocrine Gut Neoplasms: Important Lessons From Uncommon Tumors

Archives of Surgery , Volume 129 (9) – Sep 1, 1994

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References (17)

Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1994.01420330079015
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To review our experiences in order to high-light some important lessons learned in the treatment of patients with neuroendocrine gut neoplasms. Design: Retrospective analysis of case series of 70 patients with neuroendocrine gut neoplasms treated between 1983 and 1993. The clinical features of individual patients illustrate lessons in surgical treatment. Setting: University hospitals with tertiary care referral practice. Interventions: The main intervention was abdominal exploration in 43 patients, with resection of the primary tumor in 39 and of hepatic metastases in four. Main Outcome Measures: To describe the tumors seen and to identify major lessons learned. Results: Of 70 patients with neuroendocrine tumors treated, 31 had carcinoid tumors, 10 each had insulinomas and gastrinomas, five had vipomas, nine had nonfunctioning islet cell tumors, three had glucagonomas, and one each had somatostatinoma and a possible cholecystokinin-secreting tumor (or CCKoma). Important lessons learned include: (1) the importance of preoperative tumor localization; (2) in multiple endocrine neoplasia, type I syndrome, the tumor found may not be the one responsible for the patient's symptoms; (3) solitary sporadic tumors secreting multiple peptides may mimic multiple tumors in multiple endocrine neoplasia, type I syndrome; (4) one needs to be prepared for the unexpected, such as the carcinoid crisis; (5) resection may sometimes be necessary even with advanced local disease; and (6) selected patients may benefit from pancreaticoduodenectomy. Conclusions: These rare tumors are interesting in their clinical presentation and can be challenging in their treatment.(Arch Surg. 1994;129:965-972) References 1. Debas HT. Clinical significance of gastrointestinal hormones . Adv Surg . 1987: 21:157-188. 2. Bale AE, Norton JA, Wong EL. Allelic loss of chromosome 11 in hereditary and sporadic tumors related to familial multiple endocrine neoplasia type I . Cancer Res . 1991;51:1154-1157. 3. Wolfe MM, Jensen RT. Zollinger-Ellison syndrome: current concepts in diagnosis and management . N Engl J Med . 1987;317:1200-1209.Crossref 4. Larsson LI, Grimelias L, Hakanson R. Mixed endocrine pancreatic tumors producing several peptide hormones . Am J Pathol . 1975;79:271-278. 5. Townsend CM Jr, Thompson JC. Surgical management of tumors that produce gastrointestinal hormones . Annu Rev Med . 1985;36:111-126.Crossref 6. Makridis C, Oberg K, Juhlin C, et al. Surgical treatment of mid-gut carcinoid tumors . World J Surg . 1990;14:377-382.Crossref 7. Kvols LK, Moertel CG, O'Connell MJ. Treatment of the malignant carcinoid syndrome . N Engl J Med . 1986;315:663-666.Crossref 8. Debas HT, Gittes G. Somatostatin analogue therapy in functioning neuroendocrine gut tumors . Digestion . 1993;54( (suppl 1) ):68-71.Crossref 9. Vinayek R, Amantea MA, Maton PN, Frucht H, Gardner JD, Jensen RT. Pharmacokinetics of oral and intravenous omeprazole in patients with Zollinger-Ellison syndrome . Gastroenterology . 1991;101:138-147. 10. Sugg SL, Norton JA, Fraker DL, et al. A prospective study of intraoperative methods to diagnose and resect duodenal gastrinomas . Ann Surg . 1993;218:138-144.Crossref 11. Rosch T, Lightdale CJ, Botet JF, et al. Localization of pancreatic endocrine tumors by endoscopic ultrasonography . N Engl J Med . 1992;326:1721-1726.Crossref 12. Sheppard BC, Norton JA, Doppman JL, Maton PN, Gardiner JD, Jensen RT. Management of islet cell tumors in patients with multiple endocrine neoplasia: a prospective study . Surgery . 1989;106:1108-1117. 13. Kent RB, van Heerden JA, Weiland LH. Non-functioning islet cell tumors . Ann Surg . 1981;193:185-190.Crossref 14. Norton JA, Sugerbaker PH, Doppman JL, et al. Aggressive resection of metastatic disease in selected patients with malignant gastrinoma . Ann Surg . 1986; 203:352-359.Crossref 15. Kvols LK, Brown ML, O'Connell MJ. Evaluation of the radiolabelled somatostatin analog (123I-octreotide) in the detection and localization of carcinoid and islet cell tumors . Radiology . 1993;187:129-133.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Sep 1, 1994

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