Identification of primary tumors in patients presenting with metastatic gastroenteropancreatic neuroendocrine tumors

Kendall J Keck; Jessica E Maxwell; Yusuf Menda; Andrew Bellizzi; Joseph Dillon; Thomas M O'Dorisio; James R Howe

doi:10.1016/j.surg.2016.05.055

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Identification of primary tumors in patients presenting with metastatic gastroenteropancreatic neuroendocrine tumors

Journal article

Open access

Peer reviewed

Identification of primary tumors in patients presenting with metastatic gastroenteropancreatic neuroendocrine tumors

Kendall J Keck, Jessica E Maxwell, Yusuf Menda, Andrew Bellizzi, Joseph Dillon, Thomas M O'Dorisio and James R Howe

Surgery, Vol.161(1), pp.272-279

01/2017

DOI: 10.1016/j.surg.2016.05.055

PMCID: PMC5331341

PMID: 27863780

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https://www.ncbi.nlm.nih.gov/pmc/articles/5331341View

Open Access

Abstract

Patients with gastroenteropancreatic neuroendocrine tumors often present with metastases. Identification of the primary tumor is important for operative management, and therefore we sought to determine our success at identifying primary tumors with diagnostic testing and operative exploration. A clinical neuroendocrine tumor database was reviewed to identify patients presenting with metastases and primary tumor in situ. Results of radiologic, endoscopic, and operative procedures were evaluated to determine which correctly identified the primary tumor. There were 197 patients presenting with metastases and unresected primaries, 134 who had an operation and 63 managed nonoperatively. Primaries were identified preoperatively in 168 (84%), at operative exploration in 7, and were not found in 22 patients. Computed tomography found 150/197 primary tumors, somatostatin-receptor scintigraphy 88/155, and endoscopy 43/107. The sensitivity of computed tomography surpassed scintigraphy (76% vs 57%, P < .01). The primary was removed in 130/134 (97%) patients, and hepatic debulking was performed in 67%. Median survival for operative patients with small bowel and pancreatic tumors was 145 and 71 months, respectively. Imaging and endoscopy identified the primary tumor in most patients, and the majority of the others were found at exploration. Preoperative testing facilitated operative planning, allowing for resection of the primary and hepatic debulking in most patients.

Prognosis

Humans

Middle Aged

Tomography, X-Ray Computed - methods

Male

Stomach Neoplasms - pathology

Neoplasm Metastasis - diagnostic imaging

Neoplasm Invasiveness - pathology

Neuroendocrine Tumors - diagnostic imaging

Adult

Female

Intestinal Neoplasms - diagnostic imaging

Pancreatic Neoplasms - mortality

Retrospective Studies

Databases, Factual

Neuroendocrine Tumors - pathology

Intestinal Neoplasms - surgery

Neoplasms, Unknown Primary - surgery

Intestinal Neoplasms - mortality

Stomach Neoplasms - diagnostic imaging

Neoplasms, Unknown Primary - diagnostic imaging

Risk Assessment

Pancreatic Neoplasms - pathology

Pancreatic Neoplasms - surgery

Survival Rate

Treatment Outcome

Endoscopy, Digestive System - methods

Intestinal Neoplasms - pathology

Disease-Free Survival

Endosonography - methods

Laparotomy - methods

Neoplasm Metastasis - pathology

Neuroendocrine Tumors - mortality

Neuroendocrine Tumors - surgery

Neoplasm Staging

Stomach Neoplasms - surgery

Stomach Neoplasms - mortality

Pancreatic Neoplasms - diagnostic imaging

Neoplasms, Unknown Primary - pathology

Details

Title: Subtitle: Identification of primary tumors in patients presenting with metastatic gastroenteropancreatic neuroendocrine tumors
Creators: Kendall J Keck - Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
Jessica E Maxwell - Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
Yusuf Menda - Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA
Andrew Bellizzi - Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA
Joseph Dillon - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
Thomas M O'Dorisio - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
James R Howe - Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA. Electronic address: james-howe@uiowa.edu
Resource Type: Journal article
Publication Details: Surgery, Vol.161(1), pp.272-279
DOI: 10.1016/j.surg.2016.05.055
PMID: 27863780
PMCID: PMC5331341
NLM abbreviation: Surgery
ISSN: 0039-6060
eISSN: 1532-7361
Publisher: United States
Grant note: P30 CA086862 / NCI NIH HHS T32 CA148062 / NCI NIH HHS P50 CA174521 / NCI NIH HHS
Language: English
Date published: 01/2017
Academic Unit: Radiology; Pathology; Surgery; Radiation Oncology; Fraternal Order of Eagles Diabetes Research Center; Endocrinology and Metabolism; Internal Medicine
Record Identifier: 9984046908402771

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