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September 1994

Neuroendocrine Gut Neoplasms: Important Lessons From Uncommon Tumors

Author Affiliations

From the Department of Surgery, University of California—San Francisco.

Arch Surg. 1994;129(9):965-972. doi:10.1001/archsurg.1994.01420330079015

Objective:  To review our experiences in order to high-light some important lessons learned in the treatment of patients with neuroendocrine gut neoplasms.

Design:  Retrospective analysis of case series of 70 patients with neuroendocrine gut neoplasms treated between 1983 and 1993. The clinical features of individual patients illustrate lessons in surgical treatment.

Setting:  University hospitals with tertiary care referral practice.

Interventions:  The main intervention was abdominal exploration in 43 patients, with resection of the primary tumor in 39 and of hepatic metastases in four.

Main Outcome Measures:  To describe the tumors seen and to identify major lessons learned.

Results:  Of 70 patients with neuroendocrine tumors treated, 31 had carcinoid tumors, 10 each had insulinomas and gastrinomas, five had vipomas, nine had nonfunctioning islet cell tumors, three had glucagonomas, and one each had somatostatinoma and a possible cholecystokinin-secreting tumor (or CCKoma). Important lessons learned include: (1) the importance of preoperative tumor localization; (2) in multiple endocrine neoplasia, type I syndrome, the tumor found may not be the one responsible for the patient's symptoms; (3) solitary sporadic tumors secreting multiple peptides may mimic multiple tumors in multiple endocrine neoplasia, type I syndrome; (4) one needs to be prepared for the unexpected, such as the carcinoid crisis; (5) resection may sometimes be necessary even with advanced local disease; and (6) selected patients may benefit from pancreaticoduodenectomy.

Conclusions:  These rare tumors are interesting in their clinical presentation and can be challenging in their treatment.(Arch Surg. 1994;129:965-972)

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