title: Surgical Treatment of NEN of Small Bowel: A Retrospective Analysis.
abstract: BACKGROUND
  Neuroendocrine Neoplasms of the small intestine have been noticed more frequently over the past 35 years. They constitute about 25% of all NENs and 29% of all tumors of the small intestine. Due to the predominantly indolent nature and overall good prognosis, the benefit of surgical treatment is still debated.
  
  
  METHODS
  In a retrospective study, data of 83 surgically treated patients with neuroendocrine neoplasms of the small intestine, 48 males and 35 females with a median age of 62 years (range 25-86 years) were analyzed. Patient data were documented in the MaDoc database for neuroendocrine tumors of the University Medical Center of Mainz. IBM SPSS Statistics 20 was used for statistical analysis. Kaplan-Meier survival curves and Log-Rank tests, censoring patients at the time of last follow-up, were used to compare the overall survival depending on potential prognostic factors (stage, grade, surgical treatment).
  
  
  RESULTS
  At the time of diagnoses, the most common clinical symptoms were abdominal pain (n = 31, 37.3%), bowel obstruction (n = 11, 13.3%), bowel perforation and peritonitis (n = 3, 3.6%), gastrointestinal bleeding (n = 9, 10.8%), weight loss (n = 11, 13.3%), and carcinoid syndrome (n = 27, 32.5%). 65 patients (78.3%) had lymph node metastasis and in 58 patients (69.9%) distant metastasis were present. Segmental bowel resection (44) was the most common surgical procedure, followed by right hemi-colectomy (32) and explorative laparotomy (7). In most patients (78.9%), lymphadenectomy (systematic/selective) was performed. The 5-year survival of patients who underwent a systematic or a selective lymphadenectomy differed significantly (82.2 vs. 40.0%). The overall 3-, 5-, and 10-year survival rates were 88.2, 80.3, and 71.0%, respectively.
  
  
  CONCLUSIONS
  Mesenteric lymph node metastases are almost invariably present and have significant impact on patients' prognosis. Systematic lymphadenectomy prevents complications and improves the survival. Early surgical treatment should be the goal in order to prevent complications.
authors.affiliation: Clinic of General, Visceral- and Transplantation Surgery, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
authors.forename: F M
authors.initials: FM
authors.lastname: Watzka
authors.affiliation: Endocrinology and Metabolic Diseases, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Fottner
authors.affiliation: Clinic of Nuclear Medicine, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Miederer
authors.affiliation: Endocrinology and Metabolic Diseases, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
authors.forename: M M
authors.initials: MM
authors.lastname: Weber
authors.affiliation: Institute of Pathology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Schad
authors.affiliation: Clinic of General, Visceral- and Transplantation Surgery, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Lang
authors.affiliation: Clinic of General, Visceral- and Transplantation Surgery, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. musholt@uni-mainz.de.
authors.forename: T J
authors.initials: TJ
authors.lastname: Musholt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007421:Intestine, Small / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
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