At the end of 2014, I was feeling pretty good celebrating 4 years since my first ‘big’ surgery in 2010. It prompted me to write a blog – Surgery – the gift that keeps on giving. In that blog I really just wanted to say I was grateful for the early surgical treatment and as I was just about to spend another Christmas with my family, I was reminiscing what a wonderful gift it was at the time……….and of course it remains so today. Other than some detail of the surgery, I didn’t get too technical, I just wanted to generate a thankful and festive mood. However, a recent private message from a subscriber prompted me to study the current benefits of surgery for Neuroendocrine Tumours (NETs) in more detail just to ensure my understanding was still in line with best practice.
It’s very well known that NETs can present a major challenge to physicians in their recognition and treatment requirements. For example, Midgut NETs are the most common cause of carcinoid syndrome, not only for requiring surgery for primary and mesenteric tumours to minimise the risk for abdominal complications and future growth; but also for removal of liver and other metastases to palliate hormonal symptoms. Ditto for pancreatic neuroendocrine tumours (pNETs), insulinoma, gastrinoma, somatostatinoma and VIPoma often cause severe symptoms of hormone excess despite their inconspicuous size. Some tumours can be quite large and require extensive surgery to remove.
I searched reputable websites and European and North American NET treatment guidelines to find that surgical treatment of these tumours still appears to be increasingly important and not just for curative treatment (where this is possible) but also for symptom palliation and survival. Although more treatment modalities are available than ever before (e.g. radiotherapy including PRRT, liver embolisation, liver ablation, somatostatin analogues and other new drugs and chemo combinations), surgery still appears to be the mainstay treatment to be offered when it is appropriate. For some it isn’t appropriate or will be held in reserve for watch and wait scenarios or as ‘adjuvant’ treatment downstream. On paper, it appears to be the only current option for a curative scenario if the cancer is caught early enough.
I had an amazing surgeon with an impressive CV in Neuroendocrine disease. He believes in early and aggressive surgery (within normal guidelines) and always in conjunction with other treatment modalities and only when required. I found a video of one of his lectures which you may find useful. Another surgeon who talks with knowledge and passion is Dr Pommier and one of his videos can be viewed here. I’m sure there are many others. They are different characters but they both seem to believe in getting as much tumour out as early as possible and also emphasise that sometimes it can be too risky so the focus moves to other treatment. Both presentations provide statistical evidence that debulking/cytoreductive surgery can often offer a better outlook even for those with advanced neuroendocrine disease.
I think I have a soft spot for surgeons – they also seem to love their job despite it being particularly ‘gory’. On the subject of ‘gory’, I recently came across another surgical video which I found totally fascinating. This one contains amazing footage of real surgery and if you are like me, you will find this very educational. It’s also fairly recent (2014) so perhaps offers more up to date techniques. It’s also a very well structured presentation. Some of you might have seen it before and some of you could even have even been at the presentation! If you don’t have time, skip forward to approximately ’19 minutes’ and watch them take out large and small tumours of the liver using a technique called enucleation! (Click here to watch).
Hope you enjoyed this session as much as I enjoyed writing it!
Thanks for reading
I also have a private Facebook group, let me know if you’re interested.
Please Share this post