title: Toward a Preoperative Classification of Lymph Node Metastases in Patients with Small Intestinal Neuroendocrine Tumors in the Era of Intestinal-Sparing Surgery.
abstract: BACKGROUND
  In patients with small intestinal neuroendocrine tumors (siNETs), surgical resection of the primary tumor and associated mesenteric lymph nodes (LNs) is recommended, but is not well standardized and can be risky in patients with superior mesenteric vessel involvement.
  
  
  OBJECTIVE
  We aimed to evaluate the correlation between the length of resected small bowel and the number of removed LNs, and to propose a preoperative morphological classification of siNET-associated LNs.
  
  
  METHODS
  The records of patients operated on for siNETs at two expert centers between August 2005 and November 2013 were analyzed. Two specialist radiologists reviewed the preoperative imaging and classified mesenteric LNs into five stages according to their proximity to the trunk and/or branches of the superior mesenteric artery.
  
  
  RESULTS
  72 patients were included. The mean number of removed LNs was 12 ± 15 and the length of removed small intestine was 53 ± 43 cm. No correlation existed between the length of small bowel resection and the number of removed LNs. Overall, 9 (12%), 13 (18%), 36 (50%), 14 (19%) and 0 patients were classified into LN stages 0, I, II, III and IV. The correlation rate between the two observers was 0.98. Patients with LN stage III (hardly resectable) had more removed LNs than those with LN stages 0, I or II (easily removable).
  
  
  CONCLUSIONS
  Optimal lymphadenectomy is not always associated with extended small bowel resection. In the era of small bowel-sparing surgery, the preoperative classification of mesenteric LNs could help to standardize the surgical management of patients with siNETs.
authors.forename: Sophie
authors.initials: S
authors.lastname: Lardière-Deguelte
authors.forename: Louis
authors.initials: L
authors.lastname: de Mestier
authors.forename: François
authors.initials: F
authors.lastname: Appéré
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Vullierme
authors.forename: Magaly
authors.initials: M
authors.lastname: Zappa
authors.forename: Christine
authors.initials: C
authors.lastname: Hoeffel
authors.forename: Marleny
authors.initials: M
authors.lastname: Noaves
authors.forename: Hedia
authors.initials: H
authors.lastname: Brixi
authors.forename: Olivia
authors.initials: O
authors.lastname: Hentic
authors.forename: Philippe
authors.initials: P
authors.lastname: Ruszniewski
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cadiot
authors.forename: Yves
authors.initials: Y
authors.lastname: Panis
authors.forename: Reza
authors.initials: R
authors.lastname: Kianmanesh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013953:Thymus Neoplasms / Q000556:secondary* / Q000601:surgery