SURVIVAL AND RECURRENT DISEASE IN PATIENTS WITH RESECTED PRIMARY SMALL BOWEL NEUROENDOCRINE TUMOURS

Introduction Small bowel neuroendocrine tumours (SBNETS) are the most common of all GI NETs. The majority of patients present with metastatic disease. It is unclear whether resection of the primary tumour improves prognosis. Furthermore, the recurrence rate of disease in patients following “curative” resection is not previously been investigated. Aims To demonstrate if primary SBNET resection leads to improved survival and time to development of recurrent disease in patients following resection of primary tumour +/− mesenteric disease in an attempted curative resection. Methods 138 patients with SBNETs seen in our institution; median duration of follow-up was 5 years. Median age 61 (range 24–84 years). Only patients in whom current disease state was known were included in the study. Primary site: Duodenal 2.1% (3), Jejunal 2.9% (4), ileal 95% (131). Kaplan–Meier plots were constructed to determine survival. Staging was performed retrospectively using the TNM staging system proposed by ENETs.1 Results 100 patients had the primary resected, four patients had irresectable disease at laparotomy. The mean time to resection of primary from diagnosis was 5.8 months (range 0–78 months). There were no deaths within 30 days post surgery. Kaplan–Meier survival curves were constructed. There was a significant survival benefit in patients whom underwent resection of primary tumour compared to those who did not have the primary resected (120 vs 56 months, p<0.005). There were four patients with Stage 2, 23 patients with stage 3 disease and 91 with stage 4 disease. There were 10 patients in whom it was not possible to accurately stage of disease since the complete histology was not available, however, all of these patients had no evidence of recurrent disease in the initial post-operative period. No survival data were available for the remaining 10 patients. Of the patients who underwent attempted curative resection without distal metastatic disease at presentation, there were 36 patients suitable for analysis. Of these 15 of 36 (41.7%) patients have developed recurrent disease. Median period for development of recurrence was 55 months (range 11–606 months). There was no recurrence in the four patients with known stage 2 disease (4–168 months). Recurrence occurred in 8 of 23 patients (34.8%) with stage 3 disease. Conclusion This study demonstrated a marked improvement in survival in patients who underwent resection of the primary tumour. Disease recurrence is common in patients following curative resection of locally advanced small bowel NETs. Surveillance for a period of only 5 years will not identify a number of patients who will proceed to develop recurrence. Competing interests None declared. Reference 1. Rindi G, Klöppel G, Couvelard A, et al. TNM staging of midgut and hindgut (neuro) endocrine tumors: a consensus proposal including a grading system. Virchows Arch 2007;451:757–62.