Surgical management of gastro-entero-pancreatic neuroendocrine tumours

Introduction : Gastro-entero-pancreatic neuroendocrine tumours (GEP NET) are a large and differentiated group of neoplasms. Their clinical course can be various, which is conditioned, for instance, by the fact that some of these tumours are hormonally active.

Aim : To analyse symptoms that can accompany neuroendocrine tumours of the digestive system and the circumstances in which these neoplasms are diagnosed; evaluation of the results of surgical management of patients who had GEP NET detected.

Material and methods : Six patients (5 women and a 1 man) had gastro-entero-pancreatic neuroendocrine tumour diagnosed. Three female patients underwent scheduled surgical procedures due to pancreatic tumour. Two patients (a woman and a man) were operated on for acute appendicitis and carcinoid was found in the vermiform appendix after emergency appendectomy, whereas a woman who underwent cholecystectomy because of the signs of acute cholecystitis was suffering from neuroendocrine cancer of the gallbladder.

Results : In 3 patients – a woman and a man after appendectomy and also a woman after surgical excision of pancreatic insulinoma – postoperative periods were uneventful. In the rest of patients postoperative complications occurred. A woman with neuroendocrine cancer of the gallbladder died 2 months after surgery. Five remaining living patients were in follow-up. Surgical treatment was confirmed to be curative in all of them.

Conclusions : Gastro-entero-pancreatic neuroendocrine tumours are rare. Sometimes they are diagnosed preoperatively due to characteristic symptoms secondary to hormonal activity. However, gastro-entero-pancreatic neuroendocrine tumours are usually hormonally silent. Some of them are found in patients operated on because of an acute abdominal disease that can be caused by a neuroendocrine tumour. In the case of some GEP NET tumours which were resected, oncological treatment is not necessary.