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World J Gastrointest Surg. Apr 27, 2022; 14(4): 276-285
Published online Apr 27, 2022. doi: 10.4240/wjgs.v14.i4.276
Current status of surgical management of patients with gastroenteropancreatic neuroendocrine neoplasms
Rafał Stankiewicz, Michał Grąt
Rafał Stankiewicz, Michał Grąt, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw 02-097, Poland
Author contributions: Stankiewicz R conceptualized the study, did literature search, wrote the paper, and approved the final version of the article; Grąt M conceptualized the study, did literature search, critically reviewed the paper, and approved the final version of the article.
Conflict-of-interest statement: None to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rafał Stankiewicz, MD, PhD, Surgeon, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, 1A Banacha Street, Warsaw 02-097, Poland. rstankiewicz0@gmail.com
Received: October 16, 2021
Peer-review started: October 16, 2021
First decision: December 3, 2021
Revised: December 18, 2021
Accepted: April 9, 2022
Article in press: April 9, 2022
Published online: April 27, 2022
Processing time: 189 Days and 15.6 Hours
Abstract

Neuroendocrine neoplasms (NENs) of the gastroenteropancreatic system are rare and heterogeneous tumours, yet with increasing prevalence. The most frequent primary sites are the small intestine, rectum, pancreas, and stomach. For a localized disease, surgical resection with local lymph nodes is usually curative with good overall and disease free survival. More complex situation is the treatment of locally advanced lesions, liver metastases, and, surprisingly, small asymptomatic tumours of the rectum and pancreas. In this review, we focus on the current role of surgical management of gastroenteropancreatic NENs. We present surgical approach for the most frequent primary sites. We highlight the role of endoscopic surgery and the watch-and-wait strategy for selected cases. As liver metastases pose an important clinical challenge, we present current indications and contraindications for liver resection and a role of liver transplantation for metastatic NENs.

Keywords: Gastroenteropancreatic neuroendocrine neoplasms; Treatment; Management; Liver metastases; Liver transplantation; Surgery

Core Tip: Neuroendocrine neoplasms of the gastroenteropancreatic system are a rare and heterogeneous group of tumours. Due to the advancement of the diagnostic methods like new serum biomarkers and more accurate imaging modalities (including positron emission tomography), its incidence is rising. We present a review focused on up-to-date recommended surgical management of these tumours. We discuss key points of treatment for the most frequent primary sites and liver metastases. Finally, we point areas where univocal consensus is still being achieved by presenting recommendations of various Oncological and Surgical Societies.