Surgical Resection of Multiple Small Bowel Neuroendocrine Tumours Using Intraoperative Fluorescence Angiography with Indocyanine Green Dye

Surgical Resection of Multiple Small Bowel Neuroendocrine Tumours Using Intraoperative Fluorescence Angiography with Indocyanine Green Dye:



Background

Neuroendocrine tumours (NETs) are a heterogeneous group of malignancies with a small, but increasingly incidence. They usually arise sporadically, with the highest incidence being from the fifth decade onward [1, 2].



Small bowel is the third most common site of NETs after the lung and rectum, but is the most common site of NETs that develop distant metastases. Small bowel NETs (SBNETs) tend to be small and generally do not lead to symptoms until they cause partial obstruction, abdominal pain, bleeding or become metastatic, which can lead to carcinoid syndrome. In 25–44% of patients, there are multifocal primary tumours [3].



The World Health Organization (WHO) classifies NETs in well-differentiated (G1 and G2) and poorly differentiated (G3), according to their mitotic count or Ki-67 index. Surgery with curative intent is the mainstay of treatment of low-grade tumours. However, some lesions might be unresectable due to their extent. In these situations, less effective chronic...



Abbreviations

NETs

neuroendocrine tumours



SBNETs

small bowel NETs



ICG

indocyanine green dye



WHO

World Health Organization



Hb

haemoglobin



EGD

Esophagogastroduodenoscopy



PET

positron-emission tomography



CT

computed tomography



ECOG

Eastern Cooperative Oncology Group



PS

performance status