Outcome of Debulking the Mesenteric Mass in Symptomatic Patients with Locally Advanced Small Intestine Neuroendocrine Tumors
Simple Summary
Abstract
1. Introduction
2. Methods
- (a)
- (b)
- The tumor was classified as locally advanced or unresectable because mesenteric disease encircled the mesenteric vascular root above the level of the horizontal part of the duodenum and/or extended to the retroperitoneum (Table 1);
- (c)
- Patients were symptomatic with episodes of abdominal pain and/or bowel obstruction.
2.1. Statistics
2.2. Results
3. Discussion
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Resectable | Mesenteric disease (nodal metastases and desmoplasia) up to the of the outlet of the ileocolic artery from the mesenteric superior artery |
Borderline resectable | Mesenteric disease up to the level of the inferior pancreas body without encircling the mesenteric vessel root, nor the first two jejunal arteries, and without extension to the retroperitoneum |
Locally advanced or unresectable | Mesenteric disease that encircles the mesenteric vessel root, including the first two jejunal arteries, above the level of the inferior wall of the horizontal part of the duodenum and/or extension to the retroperitoneum |
Proportion of locally advanced cases of all SI-NENs (2012–2024) | 29/202 (14%) |
Age, years median (range) at Dx | 63 (46–78) |
Gender (male/female) | 23/6 |
Abdominal symptoms | 29/29 (100%) |
Abdominal pain | 22/29 (76%) |
Symptoms of bowel obstruction | 11/29 (38%) |
Weight loss | 22/29 (76%) |
Patients with stage III/stage IV disease | 2 (7%)/27 (93%) |
Previous SI-NEN surgery
| 14/29 (48%) 10/14 (71%) 4/14 (29%) |
Occlusion or compression of PV/SMV on imaging | 18/29 (62%) |
Mesenteric mass > 10 mm at level 3 on imaging | 16/29 (55%) |
Advanced mesenteric desmoplasia on imaging * | 21/29 (72%) |
Previous SSA treatment | 22/29 (76%) |
Previous PRRT treatment | 7/29 (24%) |
Carcinoid syndrome | 12/29 (41%) |
Hedinger syndrome | 1/29 (3%) |
Distant metastases
| 27/29 (93%) 23/27 (85%) 11/27 (41%) 20/27 (74%) 4/27 (15%) |
Type of procedure - Debulking MM with small bowel resection - Debulking MM with right hemicolectomy/ileocecal resection - Debulking MM with resection of ileotransversostomy - Debulking MM without bowel resection - No debulking MM, but resection of ischemic bowel - Additional resection of liver metastases | Number n = 29 14/29 (48%) 10/29 (34%) 2/29 (7%) 2/29 (7%) 1/29 (3%) 14/29 (48%) |
Operating time (min.), median (range) | 262 (156–411) |
Patients with advanced mesenteric desmoplasia intraoperatively * | 29/29 (100%) |
Patients with ≥200 cm small bowel length after debulking | 26/29 (90%) |
Grading, G1/G2/G3 | 19 (66%)/9 (31%)/1 (3%) |
LN resected in patients with debulking, median (range) | 20 (7–40) |
Postoperative complications ≥CD 3 | 4/29 (14%) |
Perioperative mortality | 1/29 (3%) |
Improvement in bowel obstruction | 11/11 (100%) |
Improvement in abdominal pain | 20/22 (91%) |
Additional SSA treatment | 28/29 (97%) |
Additional PRRT | 9/29 (31%) |
Additional local treatments (e.g., TACE, stenting SMA/SMV, duodenal stent) | 9/29 (31%) |
Additional abdominal surgery for SI-NENs | 2/29 (7%) |
Median follow-up (range) after debulking surgery, months | 28 (1–142) |
Patients alive with disease at study endpoint | 21/29 (72%) |
5-year survival after debulking surgery | 0.7 (95%CI 0.5–0.89) |
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Bartsch, D.K.; Krasser-Gercke, N.; Rinke, A.; Mahnken, A.; Jesinghaus, M.; Eilsberger, F.; Maurer, E. Outcome of Debulking the Mesenteric Mass in Symptomatic Patients with Locally Advanced Small Intestine Neuroendocrine Tumors. Cancers 2025, 17, 1318. https://doi.org/10.3390/cancers17081318
Bartsch DK, Krasser-Gercke N, Rinke A, Mahnken A, Jesinghaus M, Eilsberger F, Maurer E. Outcome of Debulking the Mesenteric Mass in Symptomatic Patients with Locally Advanced Small Intestine Neuroendocrine Tumors. Cancers. 2025; 17(8):1318. https://doi.org/10.3390/cancers17081318
Chicago/Turabian StyleBartsch, Detlef K., Norman Krasser-Gercke, Anja Rinke, Andreas Mahnken, Moritz Jesinghaus, Friederike Eilsberger, and Elisabeth Maurer. 2025. "Outcome of Debulking the Mesenteric Mass in Symptomatic Patients with Locally Advanced Small Intestine Neuroendocrine Tumors" Cancers 17, no. 8: 1318. https://doi.org/10.3390/cancers17081318
APA StyleBartsch, D. K., Krasser-Gercke, N., Rinke, A., Mahnken, A., Jesinghaus, M., Eilsberger, F., & Maurer, E. (2025). Outcome of Debulking the Mesenteric Mass in Symptomatic Patients with Locally Advanced Small Intestine Neuroendocrine Tumors. Cancers, 17(8), 1318. https://doi.org/10.3390/cancers17081318