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.