Emergency surgery influences oncological outcome in small intestinal neuroendocrine tumors

Abstract

Background and aims: Patients with small intestinal neuroendocrine tumors (siNETs) frequently present emergently due to bowel ischemia or bowel obstruction. The influence of emergency surgery on the prognosis of siNET remains controversial. The aim of this study was to investigate the association between type of presentation (emergency/elective) and oncological outcome. Methods: Clinicopathological data of patients who underwent bowel resection and were treated due to siNET at the Charité — Universitätsmedizin Berlin, Germany were analyzed retrospectively. Results: A total of 165 patients underwent bowel resection for siNET. Of these, 22.4% (n = 37) were emergency and 77.6% (n = 128) were elective procedures. A preoperative known diagnosis was less common in patients with emergency surgery (48.6% vs 85.2%; p < 0.001) and complete resections of all tumor manifestations were performed less often (32.4% vs 50.8%; p = 0.049), while more completion operations had to be performed (24.3% vs 11.1%; p = 0.049). Overall survival (OS) and progression-free survival (PFS) of emergently operated patients were reduced (5-year OS: 85.2% vs 89.5% ( p = 0.023); 5-year PFS: 26.7% versus 52.5% ( p = 0.018)). In addition, emergency surgery was negatively associated with OS after multivariable regression analysis. Conclusion: Emergency surgery in siNET patients is associated with adverse oncological outcomes including shorter OS and PFS. Prevention of emergency conditions should be emphasized in advanced disease.