Options and Considerations in the Management of Peritoneal Disease in Patients with Small Bowel Neuroendocrine Tumors

Jeremy Chang; Udhayvir S Grewal; Scott K Sherman; James R Howe

doi:10.1007/s11864-025-01364-y

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Options and Considerations in the Management of Peritoneal Disease in Patients with Small Bowel Neuroendocrine Tumors

Journal article

Open access

Peer reviewed

Options and Considerations in the Management of Peritoneal Disease in Patients with Small Bowel Neuroendocrine Tumors

Jeremy Chang, Udhayvir S Grewal, Scott K Sherman and James R Howe

Current treatment options in oncology, Vol.26(12), pp.1023-1032

12/2025

DOI: 10.1007/s11864-025-01364-y

PMCID: PMC12634710

PMID: 41082053

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Abstract

Peritoneal metastases (PM) in small bowel neuroendocrine tumors (SBNET) are challenging. These patients have worse oncologic outcomes and may have symptoms related to mechanical obstruction and hormone production. Difficult decisions apply in diagnosis, surgical selection, postoperative systemic therapy, and surveillance. To aid in these decisions, we routinely recommend obtaining somatostatin receptor based functional imaging (i.e. DOTA PET/CT) and arterial and venous phase CT preoperatively to evaluate disease burden and guide surgical planning. Disease biology should also guide surgical management. The presence of synchronous liver metastases should not exclude patients from surgery. For patients with PM and grade 1 or 2 well differentiated SBNETs, we recommend aggressive surgical cytoreduction with the goal of a completeness of cytoreduction (CC) of 0 or 1 and > 70% cytoreduction of liver metastases. For high grade (G3) well differentiated SBNETs, surgical intervention may still be considered. In patients where the extent of disease does not allow for effective cytoreduction, or where patient comorbidities preclude extensive surgery, palliative surgeries or interventions may be preferred. Postoperatively, radiologic surveillance is important to evaluate for disease progression. Some SBNET patients presenting without PM are at risk of developing PM in follow-up, especially those with liver metastases or high T stage. In patients with progression or inoperable disease, systemic therapy including somatostatin analogs (SSAs), chemotherapy or peptide receptor radionuclide therapy (PRRT) may be potential options, although the latter may pose increased risk of bowel obstruction. When cytoreducton and systemic therapy are no longer options, palliative measures should be employed. Because of this complexity, management of PM in SBNET patients is a multidisciplinary collaborative effort.

Somatostatin analogs

Peptide receptor radionuclide therapy

Peritoneal metastases

Small bowel neuroendocrine tumor

Cytoreductive surgery

UIOWA OA Agreement

Details

Title: Subtitle: Options and Considerations in the Management of Peritoneal Disease in Patients with Small Bowel Neuroendocrine Tumors
Creators: Jeremy Chang - University of Iowa
Udhayvir S Grewal - Emory University
Scott K Sherman - University of Iowa
James R Howe - University of Iowa
Resource Type: Journal article
Publication Details: Current treatment options in oncology, Vol.26(12), pp.1023-1032
DOI: 10.1007/s11864-025-01364-y
PMID: 41082053
PMCID: PMC12634710
NLM abbreviation: Curr Treat Options Oncol
ISSN: 1534-6277
eISSN: 1534-6277
Publisher: Springer Nature
Language: English
Electronic publication date: 10/13/2025
Date published: 12/2025
Academic Unit: Surgery
Record Identifier: 9985014897602771

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