Small Intestinal Neuroendocrine Tumor Clinical Trial
Official title:
Resection of the Primary Tumor vs no Resection in Asymptomatic Patients With Unresectable Synchronous Liver Metastases From siNEN
Small Intestinal neuroendocrine Tumors (SiNETs) incidence is rising. Most of siNETs primaries
are localized in jejunum/ileum. At the diagnosis, 50-70% of them present either lymph node
(LN) and/or liver metastases (LM). It is admitted that almost 30% of the patients present or
will present primary complications. Primary complications include endoluminal obstruction
and/or LN-fibrotic mesenteritis with occlusive symptoms, and less frequently haemorrhage
and/or intestinal ischemia.However, it is not clear weather this affects patient with or
without multiple liver metastases (LM). In this regard, many centres propose to perform
primary resection even in patients presenting unresectable LM. Thus, systemic reviews suggest
a possible benefit of the primary midgut siNETs resection even in patients with unresectable
LM, there is no prospective randomized trial showing the benefit of primary resection in such
patients especially those who are totally asymptomatic. Indeed, all retrospective published
series have several limitations and the results should be therefore considered with caution.
Theoretical impact of "preventive" resection of midgut primaries in patients with
unresectable LM and totally free of occlusive symptoms is controversial. Firstly, it is to
avoid primary mechanical complications, and secondly to allow targeting therapeutics to the
liver compartment. In this regard, in patients with synchronous unresectable LM from siNENs,
ENETS, UKINETS, NANETS guidelines propose, in "a case-by-case" selective approach, the
resection of the primary, while NCCN guidelines advocate to do not propose primary resection
in such patient if they are free of symptoms with low tumor burden.
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