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Surgery for NE Tumors The University of Texas M. D. Anderson Cancer Center Houston, Texas Jason B. Fleming Carcinoid / Islet Cell.

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Presentation on theme: "Surgery for NE Tumors The University of Texas M. D. Anderson Cancer Center Houston, Texas Jason B. Fleming Carcinoid / Islet Cell."— Presentation transcript:

1 Surgery for NE Tumors The University of Texas M. D. Anderson Cancer Center Houston, Texas Jason B. Fleming Carcinoid / Islet Cell

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

3 A 63-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. Midgut Carcinoid

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5 Biology of Tumor Detailed Knowledge of Pertinent Anatomy Goals of the Operation

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

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

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

9 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. Survival by NET Histology

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

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

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

13 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 Midgut Carcinoid

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

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

16 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 Midgut Carcinoid


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