title: A single institution's experience with surgical cytoreduction of stage IV, well-differentiated, small bowel neuroendocrine tumors.
abstract: BACKGROUND
  Well-differentiated neuroendocrine tumors (NETs) of the gastrointestinal tract are rare, slow-growing neoplasms. Clinical outcomes in a group of stage IV, well-differentiated patients with NETs with small bowel primaries undergoing cytoreductive surgery and multidisciplinary management at a single center were evaluated.
  
  
  METHODS
  The charts of 189 consecutive patients who underwent surgical cytoreduction for their small bowel NETs were reviewed. Information on the extent of disease, complications, and Kaplan-Meier survival were collected from the patient records.
  
  
  RESULTS
  A total of 189 patients underwent 229 cytoreductive operations. Ten percent of patients required an intraoperative blood transfusion and 3% (6 of 229) had other intraoperative complications. For all 229 procedures performed, mean (± SD) stay in the ICU was 4 ± 3 days and in the hospital was 9 ± 10 days. Before discharge, 51% of patients had no postoperative complications and 39% of patients had only minor complications. In a 30-day follow-up period from discharge, 85% of patients had no additional complications and 13% had only minor complications. The 30-day postoperative death rate was 3% (5 of 189). Mean survival from histologic diagnosis of NET was 236 months. The 5-, 10-, and 20-year Kaplan-Meier survival rates from diagnosis were 87%, 77%, and 41%, respectively.
  
  
  CONCLUSIONS
  Cytoreductive surgery in patients with well-differentiated midgut NETs has low mortality and complication rates and is associated with prolonged survival. We believe that cytoreductive surgery is a key component in the care of patients with NETs.
authors.affiliation: Louisiana State University Health Sciences Center, University Medical Center, New Orleans, LA.
authors.forename: J Philip
authors.initials: JP
authors.lastname: Boudreaux
authors.affiliation: Louisiana State University Health Sciences Center, University Medical Center, New Orleans, LA.
authors.forename: Yi-Zarn
authors.initials: YZ
authors.lastname: Wang
authors.affiliation: Louisiana State University Health Sciences Center, University Medical Center, New Orleans, LA.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Diebold
authors.affiliation: Louisiana State University Health Sciences Center, Lafayette, LA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Frey
authors.affiliation: University of Kentucky Markey Cancer Center, Lexington, KY.
authors.forename: Lowell
authors.initials: L
authors.lastname: Anthony
authors.affiliation: Ochsner Medical Center-Kenner, Kenner, LA.
authors.forename: Ann Porter
authors.initials: AP
authors.lastname: Uhlhorn
authors.affiliation: Ochsner Medical Center-Kenner, Kenner, LA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Ryan
authors.affiliation: Louisiana State University Health Sciences Center, University Medical Center, New Orleans, LA. Electronic address: ewolte@lsuhsc.edu.
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Woltering
mesh_terms: D000008:Abdominal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007078:Ileal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D007431:Intraoperative Complications / Q000453:epidemiology; D007580:Jejunal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome