{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T18:47:13Z","timestamp":1792090033286,"version":"4.4.0"},"reference-count":25,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2021,10,30]],"date-time":"2021-10-30T00:00:00Z","timestamp":1635552000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Introduction: Small-intestinal neuroendocrine tumors (siNETs) account for 25% of gastroenteropancreatic NETs. Multiple siNETs appear to develop in a limited segment of the small bowel (SB), 89% of them being located in the ileum, most often within 100 cm of the ileocecal valve (ICV). According to the European Neuroendocrine Tumor Society (ENETS) and the American Joint Committee on Cancer (AJCC), all localized siNETs should be considered for radical surgical resection with adequate lymphadenectomy irrespective of the absence of lymphadenopathy or mesenteric involvement. Surgical management of siNETs: The preoperative workout should include a precise evaluation of past medical and surgical history, focusing on the symptoms of carcinoid syndrome (flush, diarrhea, and cardiac failure). Morphological evaluation should include a CT scan including a thin-slice arterial CT, a PET\/CT with 68 Ga, and a hepatic MRI in cases of suspected metastasis. Levels of 24 h urinary 5-hydroxyindoleacetic acid are needed. Regarding surgery, the limiting component is the number of free jejunal branches allowing a resection without risk of short small bowel syndrome. The laparoscopic approach has been poorly studied, and open laparotomy remains the gold standard to explore the abdominal cavity and entirely palpate the small bowel through bidigital palpation and compression. An extensive lymphadenectomy is required. A prophylactic cholecystectomy should be performed. In case of emergency surgery, current recommendations are not definitive. However, there is expert agreement that it is not reasonable to initiate resection of the mesenteric mass without comprehensive workup and mapping. Conclusion: The surgery of siNETs is in constant evolution. The challenge lies in the ability to propose a resection without imposing short small bowel syndrome on the patients. The oncological benefits supported in the literature led to recent changes in the recommendations of academic societies. The next steps remain the dissemination of reproducible quality criteria to perform these procedures.<\/jats:p>","DOI":"10.3390\/cancers13215473","type":"journal-article","created":{"date-parts":[[2021,11,1]],"date-time":"2021-11-01T11:47:38Z","timestamp":1635767258000},"page":"5473","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Principles of Surgical Management of Small Intestinal NET"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1159-2219","authenticated-orcid":false,"given":"Arnaud","family":"Pasquer","sequence":"first","affiliation":[{"name":"Service de Chirurgie Digestive, H\u00f4pital Edouard Herriot, Hospices Civils de Lyon, F69437 Lyon, France"},{"name":"Universit\u00e9 de Lyon, Universit\u00e9 Claude Bernard Lyon 1, F69100 Villeurbanne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4199-4561","authenticated-orcid":false,"given":"Thomas","family":"Walter","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lyon, Universit\u00e9 Claude Bernard Lyon 1, F69100 Villeurbanne, France"},{"name":"INSERM, UMR 1052-UMR5286, UMR 1032 Lyon Cancer Research Center, Facult\u00e9 Laennec, F69437 Lyon, France"},{"name":"Service de Gastroent\u00e9rologie et d\u2019Oncologie Digestive, H\u00f4pital Edouard Herriot, Hospices Civils de Lyon, F69437 Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Milot","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lyon, Universit\u00e9 Claude Bernard Lyon 1, F69100 Villeurbanne, France"},{"name":"INSERM, UMR 1052-UMR5286, UMR 1032 Lyon Cancer Research Center, Facult\u00e9 Laennec, F69437 Lyon, France"},{"name":"Service de Radiologie, H\u00f4pital Edouard Herriot, Hospices Civils de Lyon, F69437 Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Val\u00e9rie","family":"Hervieu","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lyon, Universit\u00e9 Claude Bernard Lyon 1, F69100 Villeurbanne, France"},{"name":"INSERM, UMR 1052-UMR5286, UMR 1032 Lyon Cancer Research Center, Facult\u00e9 Laennec, F69437 Lyon, France"},{"name":"Service Central d\u2019Anatomie et Cytologie Pathologiques, H\u00f4pital Edouard Herriot, Hospices Civils de Lyon, F69437 Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilles","family":"Poncet","sequence":"additional","affiliation":[{"name":"Service de Chirurgie Digestive, H\u00f4pital Edouard Herriot, Hospices Civils de Lyon, F69437 Lyon, France"},{"name":"Universit\u00e9 de Lyon, Universit\u00e9 Claude Bernard Lyon 1, F69100 Villeurbanne, France"},{"name":"INSERM, UMR 1052-UMR5286, UMR 1032 Lyon Cancer Research Center, Facult\u00e9 Laennec, F69437 Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.jviscsurg.2016.11.002","article-title":"Small bowel neuroendocrine tumors surgery: Technical point\u2014With video","volume":"154","author":"Pasquer","year":"2017","journal-title":"J. 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