title: Reappraisal of lymphatic mapping for midgut neuroendocrine patients undergoing cytoreductive surgery.
abstract: BACKGROUND
  We previously reported that midgut neuroendocrine tumors (NETs) often develop alternative lymphatic drainage owing to lymphatic obstructions from extensive mesenteric lymphadenopathy, making intraoperative lymphatic mapping mandatory. We hypothesize that this innovative approach needs a longer term validation.
  
  
  METHODS
  We updated our results by reviewing 303 patients who underwent cytoreduction from November 2006 to October 2011. Of these patients, 112 had lymphatic mappings and 98 were for midgut NET primaries. Among them, 77 mappings were for the initial cytoreduction and 35 were for reexploration and further cytoreduction. The operative findings, pathology reports, and long-term surgical outcomes were reviewed.
  
  
  RESULTS
  Lymphatic mapping changed traditional resection margins in 92% of patients. Of the 35 patients who underwent reexploration without initial mapping, 19 (54%) showed a recurrence at or near the anastomotic sites. In contrast, none of the 112 mapped patients had shown signs of recurrence in a 1- to 5-year follow-up. Additionally, 20 of 45 ileocecal valves (44.4%) were spared in patients whose tumors were at the terminal ileum that, traditionally, would call for a right hemicolectomy.
  
  
  CONCLUSIONS
  With a longer follow-up, lymphatic mapping has proven to be a safe and effective way to prevent local recurrences and preserve the ileocecal valve for selected patients.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA.
authors.forename: Yi-Zarn
authors.initials: YZ
authors.lastname: Wang
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA.
authors.forename: Jean P
authors.initials: JP
authors.lastname: Carrasquillo
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA. Electronic address: Emcco1@lsuhsc.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McCord
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA.
authors.forename: Rhea
authors.initials: R
authors.lastname: Vidrine
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA.
authors.forename: Monica L
authors.initials: ML
authors.lastname: Lobo
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA.
authors.forename: S Ali
authors.initials: SA
authors.lastname: Zamin
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA.
authors.forename: Philip
authors.initials: P
authors.lastname: Boudreaux
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Woltering
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007813:Laparotomy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008208:Lymphatic System / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult