title: Surgery for small-bowel neuroendocrine tumors: is there any benefit of the laparoscopic approach?
abstract: BACKGROUND
  Surgery of small-bowel neuroendocrine (SBNE) tumors is demanding because of the need for associated extensive node dissection and assessment of possible synchronous lesions. For this reason, possible benefit of laparoscopy in SBNE tumors has not been reported to date.
  
  
  METHODS
  From 1996, all patients operated on in Beaujon Hospital for SBNE tumors were retrospectively extracted from a prospectively maintained database of intestinal resections.
  
  
  RESULTS
  Overall, 73 patients [55 % males, median age 55 years (range 27-79)] underwent small bowel resection (n = 38; 54 %), ileocolectomy (n = 25; 36 %), or both (n = 7; 10 %). In 18 patients, resection of synchronous liver metastasis was performed simultaneously. Resection was performed laparoscopically in 12 patients (16 %). Resection was R0 in 40 patients (55 %), R1 in 1 patient (1 %), and R2 in 32 patients (44 %) because of unresectable liver metastases (n = 29), nodal involvement (n = 1), or both (n = 2). Laparoscopy was associated with similar R0 (p = 0.06) and morbidity (p = 0.95) rates, but a shorter hospital stay (p = 0.003) compared with laparotomy. Median follow-up was 39 months. Progression-free survival (PFS) at 1, 3, and 5 years were 95, 83 and 75 %, respectively, for R0 patients without liver metastasis; 92, 83, and 57 %, respectively, for R0 patients with resected liver metastasis; and 82, 58 and 30 %, respectively, for R2 patients (p = 0.045). Overall survival and PFS did not show any difference when comparing the laparoscopic and open groups.
  
  
  CONCLUSIONS
  Complete resection of primary SBNE tumors with or without liver metastasis is associated with good long-term survival. In selected patients, laparoscopy for SBNE tumors is feasible and associated with a shorter hospital stay than laparotomy.
authors.affiliation: Department of Colorectal Surgery - Pôle des Maladies de l'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 100, Boulevard du Général Leclerc, 92110, Clichy, France.
authors.forename: Marleny N
authors.initials: MN
authors.lastname: Figueiredo
authors.forename: Léon
authors.initials: L
authors.lastname: Maggiori
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gaujoux
authors.forename: Anne
authors.initials: A
authors.lastname: Couvelard
authors.forename: Nathalie
authors.initials: N
authors.lastname: Guedj
authors.forename: Philippe
authors.initials: P
authors.lastname: Ruszniewski
authors.forename: Yves
authors.initials: Y
authors.lastname: Panis
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007414:Intestinal Neoplasms / Q000401:mortality / Q000601:surgery*; D007421:Intestine, Small; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome