Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are heterogeneous lesions
with varied presentations, clinical courses, and prognoses. Some of these neoplasms
display a very benign behavior, while others are extremely aggressive. Appropriately
determining which patients will benefit from curative resection attempts is often
difficult. While indications for resection of metastatic GEP-NENs continues to evolve,
those with high grade (G3) lesions have not traditionally thought to benefit from
curative intent surgery.
1
,2
The authors of this paper question this paradigm and suggest an intent-to-cure resection
is beneficial to highly selected patients with stage IV G3 GEP-NENs.
3
Their retrospective multi-site review of 15 patients reports an increase in expected
median overall survival (OS) for resected patients when compared to historical controls
treated with systemic treatment only. They astutely recognize the studies’ limitations
in that it is a highly selected cohort in which an intent-to-treat analysis is not
possible to perform. Despite these shortcomings, a few key findings are very enlightening.To read this article in full you will need to make a payment
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References
- Isolated liver metastases from neuroendocrine tumors: does resection prolong survival?.J Am Coll Surg. 1998; 187: 88-92
- Neuroendocrine metastases to the ovaries are significantly associated with small bowel neuroendocrine tumors and carcinomatosis.Am J Surg. 2020; 219: 795-799
- Radical intended surgery for highly selected stage IV neuroendocrine neoplasms G3.Am J Surg. 2020;
- Histologic grade is correlated with outcome after resection of hepatic neuroendocrine neoplasms.Cancer. 2008; 113: 126-134
- Progression and survival results after radical hepatic metastasectomy of indolent advanced neuroendocrine neoplasms (NENs) supports an aggressive surgical approach.Surgery. 2011; 149: 209-220
- The high-grade (WHO G3) pancreatic neuroendocrine tumor category is morphologically and biologically heterogenous and includes both well differentiated and poorly differentiated neoplasms.American Journal of Surgical Pathology. vol. 39. Lippincott Williams and Wilkins, 2015: 683-690
- Are G3 ENETS neuroendocrine neoplasms heterogeneous?.Endocr Relat Canc. 2013; 20: 649-657
Article info
Publication history
Published online: May 28, 2020
Accepted:
May 6,
2020
Received in revised form:
May 5,
2020
Received:
May 5,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
