Debulking surgery for small intestine neuroendocrine tumors

Neuroendocrine tumors (NETs) include heterogeneous neoplasms that can be functional or symptomatically active (functioning) or non-functioning. The overall incidence of NETs is growing faster than the incidence of all human malignancies. NETs are the second most common gastrointestinal cancers, characterized by frequent liver metastasis, which is a major factor affecting the quality of life and significant survival of patients. Cytoreductive treatment of liver metastases (NELM) is the method of choice aimed at ensuring prolongation of patient survival and improving control of hormonal symptoms resistant to conservative therapy. Surgical resection of metastases is indicated in patients with well-differentiated (G1/G2) tumors, while its feasibility and complexity in severity dictate the degree of liver involvement. As a result of advances in surgical techniques in recent years, 1- and 2-stage or repeat liver resections are performed safely and effectively by surgeons with the treatment of NETs. The wide range of interventional radiological treatments for NELM with limitations requires reasons, which is the basis for adjunctive or alternative surgery. In general, liver-directed therapies can precede the administration of systemic molecular targeted agents and chemotherapy for patients with metastatic stage and severe liver disease, which leads to the fact that patients continue to be treated only with somatostatin analogues (SAA). Cytoreductive surgery of NETs is not limited to liver metastases, but is also used in peritoneal carcinomatosis. The large variability of clinical manifestations and the prevalence of the tumor process determine the need for an individual regimen for each patient within the framework of the MDT. In this article, we discuss the surgical approach to metastatic small bowel NETs: primary tumor, liver metastases and peritoneal carcinomatosis.