DIAGNOSIS AND SURGICAL TREATMENT OF NEUROENDOCRINE TUMORS OF THE PANCREAS AND GASTROINTESTINAL TRACT

Aim. To identify the major clinical manifestations and assess current capabilities of laboratory and instrumental  dignostic methods for neuroendocrine tumors of the pancreas and gastrointestinal to justify the choice of surgical treatment.

Materials and Methods. Results of treatment of 202 patients with neuroendocrine tumors are presented. There were 124 patients  with pancreatic  tumors  and  78 patients  with tumors  of various parts of gastrointestinal  tract.  Diagnosis  of neuroendocrine tumors included laboratory confirmation of clinical neuroendocrine syndrome and topical diagnosis. Surgical treatment was applied  in 199 patients.  Long-term  results were studied  based on regression of clinical  and laboratory manifestations of neuroendocrine pathology and 5-year survival.

Results. Clinical  manifestations  of gastrointestinal  neuroendocrine tumors  are nonspecific  in 90% of patients  that extends the terms of diagnosis. The sensitivity of laboratory methods for diagnosis of pancreatic neuroendocrine tumors was 96%, for gstrointestinal tract – 92%. The most accessible methods of topical diagnosis of pancreatic neuroendocrine tumors  are CT and endoscopic  ultrasound  with sensitivity 75% and 91%, respectively. It is advisable to complement diagnosis by intraoperative  sonography.  Sensitivity of endoscopic  methods  of investigation (fibrogastroduodenoscopy, fibrocolonoscopy) in the diagnosis of gastrointestinal neuroendocrine tumors is 96.2%. PET with 18-fluorodeoxyglucose is an optional method  of detecting the tumoral process generalization.  Surgical treatment eliminated  the symptoms of neuroendocrine syndrome  and  provided  overall 5-year  survival of 69.3 ± 4.7% in radically  operated  patients  with pancreatic  neuroendocrine tumors and 63.0 ± 5.2% in patients with gastrointestinal neuroendocrine tumors.

Conclusion. Laboratory  and  instrumental  methods  confirm  clinical  neuroendocrine syndrome  and  localized  tumors in pancreas and different parts of gastrointestinal  tract. Surgical treatment can eliminate symptoms of neuroendocrine syndrome, improve 5-year survival and quality of life.

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