# Oncological Outcomes after Elective and Emergency Resection of Small Intestinal Neuroendocrine Tumours

## TL;DR

This study compares outcomes of emergency versus elective surgery for small intestinal neuroendocrine tumors and finds no significant differences in survival or complications.

## Contribution

The study provides insights into the impact of surgical timing on oncological outcomes for small intestinal neuroendocrine tumors.

## Key findings

- Emergency surgery was associated with limited preoperative staging and higher R2 resections.
- No significant differences in overall survival or recurrence-free survival were observed between emergency and elective surgeries.
- Emergency cases had higher disease-specific mortality but no increased in-hospital complications.

## Abstract

Small intestinal neuroendocrine tumour (siNET) has distinct features and disease course compared to other gastrointestinal neuroendocrine tumours. While they mostly present with subtle symptoms, they also can present acutely requiring emergency surgical intervention. We assessed the impact of surgical intervention timing on oncological outcomes of siNET.

A retrospective observational single centre cohort study of all patients diagnosed with siNET, and received surgical intervention at a tertiary level hospital between 2008 and 2025.

A total of 66 patients were diagnosed with SiNET. 22 patients were excluded due to incomplete data (9 patients) and not meeting the eligibility criteria (13 patients). Total of 44 patients met the inclusion criteria, with 30% underwent emergency resection (n = 13) and 70% underwent elective resection (n = 31). Small bowel obstruction represented the most common cause for emergency presentations (61%), while incidental radiological findings (39%) and carcinoid syndrome (35%) accounted for most elective presentations. Emergency cases were associated with the absence of pre-operative somatostatin receptor imaging, less findings of mesenteric mass (31% vs. 81%), more likelihood of post operative macroscopic residual disease (46% vs. 23%) and disease specific mortality (75% vs. 23%). However, there was no statistically significant difference between the two groups in primary and secondary oncological outcomes. There were no operative or in-hospital mortality in either group as well as no significant difference in complications rates between the groups.

Although emergency surgery was associated with limited preoperative staging and higher proportion of R2 resections, no statistically significant differences in overall survival, recurrence-free survival, carcinoid symptom resolution or local complications were observed. However, these results need to be interpreted cautiously due to the small sample size of the study.