Overview
Small intestinal neuroendocrine tumors (siNETs) are a distinct subset of gastrointestinal neuroendocrine tumors characterized by varied presentations, ranging from subtle symptoms to acute conditions necessitating emergency surgery. The timing of surgical intervention significantly impacts oncological outcomes in these patients.Diagnosis
Clinical Presentation: Includes small bowel obstruction, incidental radiological findings, and carcinoid syndrome 1.
Diagnostic Imaging: Preoperative somatostatin receptor imaging is recommended but often lacking in emergency cases 1.
Pathological Confirmation: Histological examination confirms the diagnosis 2.Management
Surgical Intervention: Elective resection is preferred over emergency resection to optimize oncological outcomes 12.
Emergency Surgery: Indicated for acute presentations like bowel ischemia or obstruction, but associated with worse prognosis 2.
Preoperative Assessment: Preoperative diagnosis is more common in elective cases, potentially improving outcomes 2.Special Populations
Emergency Presentations: More frequent in elderly patients due to complications like bowel obstruction 1.
Comorbidities: Presence of comorbidities may necessitate emergency interventions, impacting prognosis negatively 12.Key Recommendations
Prioritize Elective Resection to improve overall survival and progression-free survival in siNET patients (Evidence: Moderate 12).
Enhance Preoperative Diagnosis through routine somatostatin receptor imaging to facilitate elective surgery (Evidence: Moderate 1).
Prevent Emergency Presentations by vigilant monitoring and early intervention in high-risk patients to mitigate adverse oncological outcomes (Evidence: Expert opinion 2).References
1 Alibrahim I, Fryer D, Gupta S, Peace A, Vo MT, Jain A et al.. Oncological Outcomes after Elective and Emergency Resection of Small Intestinal Neuroendocrine Tumours. Journal of gastrointestinal cancer 2026. link
2 Butz F, Supper L, Reinhard L, Dukaczewska A, Jann H, Fehrenbach U et al.. Emergency surgery influences oncological outcome in small intestinal neuroendocrine tumors. Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society 2024. link