Toward Preoperative Classification of Lymph-Node Metastases in Patients with Small Intestine Neuroendocrine Tumours in the Era of Intestinal-Sparing Surgery.
Fiche publication
Date publication
octobre 2015
Auteurs
Membres identifiés du Cancéropôle Est :
Pr CADIOT Guillaume, Pr HOEFFEL Christine
Tous les auteurs :
Lardiere-Deguelte S, de Mestier L, Appere F, Vullierme MP, Zappa M, Hoeffel C, Noaves M, Brixi H, Hentic O, Ruszniewski P, Cadiot G, Panis Y, Kianmanesh R
Lien Pubmed
Résumé
INTRODUCTION: In patients with small intestinal neuroendocrine tumours (siNET), the surgical resection of the primary tumour and associated mesenteric lymph nodes (LN) is recommended but is not well standardized and can be risky in patients with superior mesenteric vessels involvement. We aimed to evaluate the correlation between the length of resected small bowel and the number of removed LN, and to propose a preoperative morphological classification of siNET-associated LN. METHODS: Records of patients operated on for siNET at two expert centers between August 2005 and November 2013 were analyzed. Two specialist radiologists reviewed the preoperative imaging and classified mesenteric LN into 5 stages according to their proximity to the truck and/or branches of the superior mesenteric artery. RESULTS: Seventy-two patients were included. The mean number of removed LN was 12 +/- 15 and the length of removed small intestine 53 +/- 43 cm. No correlation existed between the length of small bowel resection and the number of removed LN. Overall, 9 (12%), 13 (18%), 36 (50%), 14 (19%) and 0 patients were classified into LN-stage 0, I, II, III and IV. The correlation rate between the two observers was 0.98. Patients with LN-stage III (hardly resectable) had more removed LN than those with LN-stages 0, I or II (easily removable). CONCLUSION: An optimal lymphadenectomy is not always associated to an extended small bowel resection. In the era of small bowel-sparing surgery, the preoperative classification of mesenteric LN could help standardizing the surgical management of patients with siNET.
Référence
Neuroendocrinology. 2015 Oct 8.