Gastroenteropancreatic neuroendocrine neoplasms. Surgical treatment

Background. Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) constitute a heterogeneous group of tumors. Prognosis and therapy differ significantly from adenocarcinomas of the gastrointestinal tract. Apart from surgery biotherapy, chemotherapy, radiopeptide therapy, and local ablation are available treatment options. Objectives. The review describes the current surgical treatment strategies for GEP-NENs. Materials and methods. Publications and established guidelines for the treatment of neuroendocrine neoplasms were evaluated. Results. Because of the variable biological behavior, the possible hormone activity, and the frequently associated genetic predisposition, GEP-NENs present complex clinical pictures. The differentiated therapy is based on the comprehensive evaluation of the clinical situation. Apart from surgical resection the therapeutic spectrum encompasses biotherapy, chemotherapy, peptide receptor radionuclide therapy (PRRT), and local ablative methods. Surgical treatment is the only curative option and therefore of central importance. However, owing to the limited evidence referring to indication, optimal time, and the necessary extent of resection, detailed information is not outlined in many areas in the current guidelines. Conclusions. The surgical strategy is still predominantly guided by center-specific experience. The assessment of preoperative findings and the determination of the optimal strategy should be discussed on specialized interdisciplinary boards.