title: Aggressive Surgical Approach to the Management of Neuroendocrine Tumors: A Report of 1,000 Surgical Cytoreductions by a Single Institution.
abstract: BACKGROUND
  Neuroendocrine tumors (NETs) are rare neoplasms. Our group has treated more than 2,000 NET patients and has performed more than 1,000 surgical cytoreductive procedures.
  
  
  METHODS
  Records of 834 NET patients who underwent surgical cytoreduction at our institution were reviewed. Demographic information, intraoperative findings, extent of disease, complications, and survival rates were calculated.
  
  
  RESULTS
  Eight hundred patients underwent 1,001 cytoreductive operations. Sixty-five percent had small bowel primaries. One hundred and thirty-eight patients presented with an unknown primary site, which was localized intraoperatively in 89% of these cases. The intraoperative complication rate was 9%. The incidence of intraoperative carcinoid crisis was 1%. Mean ± SD operative time was 368 ± 146 minutes. Mean ± SD hospital stay was 9 ± 10 days. Minor postoperative complications occurred after 43% of procedures and major postoperative complications were noted after 19% of procedures. The 30-day postoperative mortality rate was 2%. Median overall survival (OS) for patients with pancreatic NETs was 124 months. The 5-, 10-, and 20-year OS rates for patients with pancreatic NETs were 67%, 51%, and 36%, respectively. The life expectancy difference (between OS and actuarial survival) after surgical cytoreduction for patients with pancreatic NETs was 16.6 years. Median OS for patients with small bowel NETs was 161 months. The 5-, 10-, and 20-year OS rates for patients with small bowel NETs were 84%, 67% and 31%, respectively. The life expectancy difference after surgical cytoreduction for patients with small bowel NETs was 11.7 years.
  
  
  CONCLUSIONS
  Surgical cytoreduction in NET patients has low morbidity and mortality rates and results in prolonged survival. We believe that surgical cytoreduction should play a major role in the care of patients with NETs.
authors.affiliation: Louisiana State University Health Sciences Center, New Orleans, LA. Electronic address: ewolte@lsuhsc.edu.
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Woltering
authors.affiliation: Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Brianne A
authors.initials: BA
authors.lastname: Voros
authors.affiliation: Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: David T
authors.initials: DT
authors.lastname: Beyer
authors.affiliation: Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Yi-Zarn
authors.initials: YZ
authors.lastname: Wang
authors.affiliation: Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Ramcharan
authors.initials: R
authors.lastname: Thiagarajan
authors.affiliation: Neuroendocrine Tumor Program, Ochsner Medical Center, Kenner, LA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Ryan
authors.affiliation: Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Anne
authors.initials: A
authors.lastname: Wright
authors.affiliation: Neuroendocrine Tumor Program, Ochsner Medical Center, Kenner, LA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Ramirez
authors.affiliation: Neuroendocrine Tumor Program, Ochsner Medical Center, Kenner, LA.
authors.forename: M Jennifer
authors.initials: MJ
authors.lastname: Ricks
authors.affiliation: Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: J Philip
authors.initials: JP
authors.lastname: Boudreaux
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D065426:Cytoreduction Surgical Procedures; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult