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GI Neuroendocrine Tumors

Surgery for NE Tumors The University of Texas M. D. Anderson Cancer Center Houston, Texas Jason B. Fleming Carcinoid / Islet Cell. GI Neuroendocrine Tumors. Midgut Carcinoid Tumors Pancreatic Neuroendocrine Tumors. Biology of Tumor Detailed Knowledge of Pertinent Anatomy

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GI Neuroendocrine Tumors

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  1. Surgery for NE TumorsThe University of TexasM. D. Anderson Cancer CenterHouston, TexasJason B. FlemingCarcinoid / Islet Cell

  2. GI Neuroendocrine Tumors • Midgut Carcinoid Tumors • Pancreatic Neuroendocrine Tumors • Biology of Tumor • Detailed Knowledge of Pertinent Anatomy • Goals of the Operation Important Variables (assuming patient is suitable candidate)

  3. Midgut Carcinoid A63-year-old man has an ulcerated mass at the ileocecal valve identified during routine colonoscopy. Biopsy identifies a well-differentiated neuroendocrine tumor. He is taken to the operating room for planned laparoscopic right hemicolectomy.

  4. Biology of Tumor • Detailed Knowledge of Pertinent Anatomy • Goals of the Operation

  5. Variability in Neuroendocrine Tumors Low Grade NET • Islet Cell Carcinoma (pancreas) • Carcinoid • Forgut (Lung (typical, atypical), Thymic) • Midgut (SB) • Hindgut (CR)

  6. Genetic Differences of Carcinoid ILEAL NON-ILEAL GI Kim do, et al. Genes Chromosomes Cancer. 2008

  7. Survival of NET by Site and Stage Localized Regional Survival probability Months Distant Median survival, months Survival probability Yao, et al. JCO, 2008.

  8. Survival by NET Histology Carcinoid/islet cell: well-differentiated Carcinoid/islet cell: unspecified grade Carcinoid/islet cell: moderately differentiated Neuroendocrine: poorly differentiated Neuroendocrine: undifferentiated Neuroendocrine: unspecified grade Yao, et al. JCO, 2008.

  9. Midgut Carcinoid • Biology of Tumor • Prognosis is favorable • Regional lymph node metastasis likely • Detailed Knowledge of Pertinent Anatomy • Goals of the Operation

  10. Anticipated Lymphatic Drainage 3rd 2nd 1st Wang, et al Surgery. 2009 Dec;146(6):993-7

  11. Mesentery Arterial Anatomy SMV, ileal br Pancreas D Ohrvall UWorld J Surg 2000; 24: 1402–1408.

  12. Midgut Carcinoid • Biology of Tumor • Prognosis is favorable • Regional lymph node metastasis likely • Detailed Knowledge of Pertinent Anatomy • Predictable Lymphatic Chain at Risk • Dual Venous Drainage of Mesentery • Redundant Arterial Supply • Goals of the Operation

  13. Palliative Benefits of R0 Resection 82% of the patients (n=125) demonstrated complete or partial symptom alleviation Makridis, World J Surg. 1996

  14. Affect of Surgery on Survival Retrospective review of 314 patients Hellman P, World J Surg. 2002

  15. Midgut Carcinoid • Biology of Tumor • Prognosis is favorable • Regional lymph node metastasis likely • Detailed Knowledge of Pertinent Anatomy • Predictable Lymphatic Chain at Risk • Dual Venous Drainage of Mesentery • Redundant Arterial Supply • Goals of the Operation • Palliative at least • Potentially Curative at best • R0 resection with bowel preservation

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