Prognostic Effect of Lymph Node Metastases and Mesenteric Deposits in Neuroendocrine Tumors of the Small Bowel.
Federica GrilloManuela AlbertelliPasqualino MalandrinoAndrea DottoGenoveffa PizzaGiuseppe CittadiniAnnamaria ColaoAntongiulio FaggianoPublished in: The Journal of clinical endocrinology and metabolism (2022)
Well-differentiated, low-grade neuroendocrine tumors (NETs) are the most frequent tumor types of the small bowel. Despite their generally indolent growth patterns and grade, these tumors tend to metastasize; indeed, at presentation, approximately 50% show nodal metastases and 30% of patients have distant metastases, even though they potentially show long survival. Little is available in the literature concerning the optimal nodal yield in small-bowel resections, and the clinical significance of nodal metastases and lymph node ratio (LNR) at this site is still debated. The aim of this review, through a systematic literature search, is to explore and analyze data regarding nodal status, adequacy of lymphadenectomy, and LNR on the prognosis of small bowel NETs using defined end points (progression-free survival, recurrence-free survival, and overall survival). Some surgical series have demonstrated that extended regional mesenteric lymphadenectomy, together with primary tumor resection, is associated with improved patient survival, and LNR is proving a prognostically important parameter. The new feature of mesenteric tumor deposits (MTDs; neoplastic deposits found in the mesenteric perivisceral adipose tissue that are not LN associated) seems to be a better prognostic predictor in small-bowel NETs compared to nodal metastases, and this feature is explored and critiqued in this review. In particular, increasing number of tumor deposits is correlated with increased risk of disease-specific death, and MTDs seem to correlate with peritoneal carcinomatosis.
Keyphrases
- small bowel
- lymph node
- free survival
- neuroendocrine tumors
- neoadjuvant chemotherapy
- sentinel lymph node
- low grade
- adipose tissue
- systematic review
- machine learning
- end stage renal disease
- newly diagnosed
- early stage
- chronic kidney disease
- insulin resistance
- type diabetes
- squamous cell carcinoma
- hodgkin lymphoma
- big data
- lymph node metastasis
- case report