title: Role of Staging in Patients with Small Intestinal Neuroendocrine Tumours.
abstract: Small bowel neuroendocrine tumours are the commonest malignancy arising in the small intestine and have substantially increased in incidence in recent decades. Patients with small bowel neuroendocrine tumours commonly develop lymph node and/or distant metastases. Here, we examine the role of staging in 84 surgically treated patients with small bowel neuroendocrine tumours, comparing diagnostic information yielded from morphological, functional and endoscopic modalities. Furthermore, we correlate pre-operative staging with intra-operative findings in a sub-cohort of 20 patients. The vast majority of patients had been histologically confirmed to have low-grade (Ki-67 <2%) disease; however, lymph node and distant metastases were observed in 74 (88.1%) and 51 (60.7%) of patients at presentation, respectively. Liver metastases were evident in 48 (57.1%) patients, with solely peritoneal and bone metastases observed in 2 (2.4%) and 1 (1.2%) patients, respectively. Forty patients (47.6%) received multimodal treatment. In our sub-cohort analysis, pre-operative imaging understaged disease in 14/20 (70%) when compared with intra-operative findings. In patients with multifocal primary tumours and miliary liver metastases, no imaging modality was able to detect entire disease spread. Overall, presently available imaging modalities heavily underestimate disease stage, with meticulous intra-operative abdominal examination being superior to any imaging technology. Multimodal treatment has an important role in prolonging survival.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK.
authors.forename: Ashley Kieran
authors.initials: AK
authors.lastname: Clift
authors.affiliation: Department of Surgery, St. Mark's Hospital, London, UK.
authors.forename: Omar
authors.initials: O
authors.lastname: Faiz
authors.affiliation: Department of Nuclear Medicine, Imperial College London, London, UK.
authors.forename: Adil
authors.initials: A
authors.lastname: Al-Nahhas
authors.affiliation: Department of Nuclear Medicine, University Hospital Essen, Essen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bockisch
authors.affiliation: Department of Surgery, Westkuesten Klinikum Heide, Heide, Germany.
authors.forename: Marc Olaf
authors.initials: MO
authors.lastname: Liedke
authors.affiliation: Department of Surgery, Westkuesten Klinikum Heide, Heide, Germany.
authors.forename: Erik
authors.initials: E
authors.lastname: Schloericke
authors.affiliation: Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK.
authors.forename: Harpreet
authors.initials: H
authors.lastname: Wasan
authors.affiliation: Department of Gastroenterology, Imperial College London, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Martin
authors.affiliation: Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Ziprin
authors.affiliation: Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK.
authors.forename: Krishna
authors.initials: K
authors.lastname: Moorthy
authors.affiliation: Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK. a.frilling@imperial.ac.uk.
authors.forename: Andrea
authors.initials: A
authors.lastname: Frilling
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004724:Endoscopy; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000473:pathology* / Q000601:surgery; D007421:Intestine, Small / Q000473:pathology* / Q000601:surgery; D008113:Liver Neoplasms / Q000556:secondary; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D018358:Neuroendocrine Tumors / Q000473:pathology* / Q000601:surgery
keywords: Neuroendocrine tumours; Small bowel; Staging; Surgery