Surgery May Not be Appropriate for Metastatic Neuroendocrine Tumors

Guidelines suggest that patients with endocrine intestinal tumors should undergo surgery.

Patients with neuroendocrine tumors that have metastasized further than the intestines should not receive surgery prior to experiencing abdominal symptoms, according to a new study published by JAMA Oncology.

The authors said these results may prevent unnecessary surgeries and associated risks among patients with neuroendocrine tumors.

Neuroendocrine tumors can grow in many places throughout the body, including the pancreas, adrenal glands, gastrointestinal tract, lungs, and brain. Treatment and patient outcomes largely depend on where the tumor originated.

Current guidelines suggest that patients with small endocrine intestinal tumors should undergo surgery immediately. However, the new findings suggest that receiving surgery before symptom onset does not impact survival, according to the authors.

Delaying surgery for these patients was found to reduce the risk of complications, including intestinal obstructions that require additional surgery, according to the study.

“The course of events is relatively common, because small neuroendocrine tumours [sic] are often first detected when they have spread beyond the intestine, usually to the liver, and surgery is then recommended promptly,” said study author Peter Stålberg, MD, PhD.

In the study, the authors followed 363 patients with neuroendocrine cancer. Patients were grouped based on whether they received surgery within 6 months of diagnosis, whether they underwent nonsurgical treatment, or had surgery after 6 months.

The study examined overall survival, length of hospital stay, morbidity and mortality, and reoperation rates among the cohorts.

“We found nothing to indicate that surgery carried out within 6 months after receiving a diagnosis produces better results than nonsurgical treatment until the patient presents with abdominal-related symptoms, such as pain or signs of intestinal obstruction,” Dr Stålberg said.

The data also showed that morbidity and mortality rates did not differ between the cohorts, suggesting no benefit to surgery, according to the study.

While surgery may alleviate certain symptoms, the authors note that many cancer drugs can also elicit symptom control and prevent further metastasis, according to the study.

The authors said these findings may impact cancer care and deter unnecessary surgeries, which could reduce complications and lower healthcare costs.

The researchers are currently planning to compare the effects of early surgical intervention and delaying surgery until a patient experiences abdominal symptoms, according to the study.

“We hope our findings have major significance, partly through more effective use of care resources, but above all, for the many patients who will run a reduced risk of unnecessary surgeries and complications in the future,” said study author Olov Norlén, MD, PhD.