Laparoscopic resection of pancreatic neuroendocrine tumors

Pancreatic neuroendocrine tumors(PNETs)are a rare heterogeneous group of endocrine neoplasms.Surgery remains the best curative option for this type of tumor.Over the past two decades,with the development of laparoscopic pancreatic surgery,an increasingly larger number of PNET resections are being performed by these minimally-invasive techniques.In this review article,the various laparoscopic surgical options for the excision of PNETs are discussed.In addition,a summary of the literature describing the outcome of these treatment modalities is presented.

Non-functioning pancreatic neuroendocrine tumors: Surgery or observation?

Incidentally detected, sporadic, nonfunctional pancreatic neuroendocrine tumors are increasingly diagnosed on imaging studies performed for unrelated purposes. Although their resection is usually recommended, controversy still exists regarding their optimal management, due to their highly variable and difficult to predict biologic behavior. Recently, several studies and guidelines advocated an expectant management approach in small size, low grade, incidentally diagnosed nonfunctional pancreatic neuroendocrine tumors. The aim of this study is to review and summarize the available literature addressing nonfunctional pancreatic neuroendocrine tumors, with an emphasis on surgical management controversies.

Nutritional and vitamin status in patients with neuroendocrine neoplasms

Symptoms of gastroenteropancreatic located neuroendocrine neoplasms(GEPNENs) are often related to food intake and manifest as abdominal pain or diarrhoea which can influence patients nutritional status. Malnutrition is common in cancer patients and influences quality of life, treatment options and survival but is also present in up to 40% of patients with GEP-NENs. As part of malnutrition there are often deficiencies in fat-soluble vitamins, mainly vitamin D. Little knowledge exists on trace elements. Several factors influence the development of malnutrition such as size and localisation of the primary tumour as well as metastases, side effects from treatment but also hormone production of the tumour itself. One of the main influencing factors leading to malnutrition is diarrhoea which leads to dehydration and electrolyte disturbances. Treatment of diarrhoea should be guided by its cause. Screening for malnutrition should be part of routine care in every GEP-NEN patient. Multidisciplinary treatment including dietician support is necessary for all malnourished patients with GEP-NENs.

Advanced small-bowel well-differentiated neuroendocrine tumours:An international survey of practice on 3rd-line treatment

BACKGROUND Somatostatin analogues are an established first-line therapy for well differentiated small bowel neuroendocrine tumours(Wd-SBNETs),while and peptide receptor radionuclide therapy(PRRT)is frequently used as a second-line therapy.Adequate treatment selection of third-line treatment remains challenging due to the limited prospective data currently available on the best therapeutic sequence.AIM To understand current practice and rationale for decision-making by physicians in the 3rd-line setting by building an online survey.METHODS Weighted average(WA)of likelihood of usage between responders(1 very unlikely;4 very likely)was used to reflect the relevance of factors explored.RESULTS Replies from representatives of 28 centers were received(5/8/2020-21/9/2020);medical oncologist(53.6%),gastroenterologist(17.9%);United Kingdom(21.4%),Spain(17.9%),Italy(14.3%).Majority from European Neuroendocrine Tumor Society(ENETS)Centres of Excellence(57.1%),who followed ENETS guidelines(82.1%).Generally speaking,3rd-line treatment for Wd-SBNETs was:everolimus(EVE)(66.7%),PRRT(18.5%),liver embolization(LE)(7.4%)and interferon-alpha(IFN)(3.7%);chemotherapy(0%);decision was based on clinical trial data(59.3%),or personal experience(22.2%).EVE was most likely used if Ki-67<10%(WA 3.27/4)or age<70 years(WA 3.23/4),in the 3rd-line setting(WA 3.23/4);regardless of presence/absence of carcinoid syndrome(CS),rate of progression or extent of disease.Chemotherapy was mainly utilised only if rapid progression(within 6 mo)(WA 3.35/4),Ki-6710%-20%(WA 2.77/4),negative somatostatin receptor imaging(WA 2.65/4)or high tumour burden(WA 2.77/4);temozolomide or streptozocin was used with capecitabine or 5-fluorouracil(5-FU)(57.7%),FOLFOX(5-FU combined with oxaliplatin)(23.1%).LE was selected if presence of CS(WA 3.24/4)or Ki-67<10%(WA 2.8/4),after progression to other treatments(WA 2.8/4).IFN was rarely used(WA 1.3/4).CONCLUSION Everolimus was the most frequently used therapeutic option in the third-line setting.The most important factors for decision-making included Ki-67,rate of progression,functionality and tumour burden;since this decision is based on multiple factors,it highlights the need for a multidisciplinary assessment.

Metastatic type 1 gastric carcinoid:A real threat or just a myth?

AIM:To describe disease characteristics and treatment modalities in a group of rare patients with metastatic gastric carcinoid type 1(GCA1).METHODS:Information on clinical,biochemical,radiological,histopathological findings,the extent of the disease,as well as the use of different therapeutic modalities and the long-term outcome were recorded.Patients’data were assessed at presentation,and thereafter at 6 to 12 monthly intervals both clinically and biochemically,but also endoscopically and histopathologically.Patients were evaluated for the presence of specific symptoms;the presence of autoimmune disorders and the presence of other gastrointestinal malignancies in other family members were also recorded.The evaluation of response to treatment was defined using established WHO criteria.RESULTS:We studied twenty consecutive patients with a mean age of 55.1 years.The mean follow-up period was 83 mo.Twelve patients had regional lymph node metastases and 8 patients had liver metastases.The primary tumor mean diameter was 20.13±10.83mm(mean±SD).The mean Ki-67 index was 6.8%±11.2%.All but one patient underwent endoscopic or surgical excision of the tumor.The disease was stable in all but 3 patients who had progressive liver disease.All patients remained alive during the follow-up period.CONCLUSION:Metastatic GCA1 carries a good overall prognosis,being related to a tumor size of≥1 cm,an elevated Ki-67 index and high serum gastrin levels.

激素在患神经性厌食症的青春期少女月经恢复中的作用

Neuroendocrine abnormalities in anorexia nervosa (AN) include hypercortisolemia,hypogonadism,and hypoleptinemia,and neuroendocrine predictors of menstrual recovery are unclear.Preliminary data suggest that increases in fat mass may better predict menstrual recovery than leptin. High doses of cortisol decrease luteinizing hormone (LH) pulse frequency,and cortisol predicts regional fat distribution. We hypothesized that an increase in fat mass and decrease in cortisol would predict menstrual recovery in adolescents with AN. Thirty-three AN girls 12-18 y old and 33 controls were studied prospectively for 1 y. Body composition dual energy x-ray absorptiometry(DXA) ,leptin,and urinary cortisol (UFC) were measured at 0,6,and 12mo. Serum cortisol was measured overnight (every 30min) in 18 AN subjects and 17 controls. AN subjects had higher UFC/cr·m2 and cortisol area under curve (AUC),and lower leptin levels than controls. Leptin increased significantly with recovery. When menses-recovered AN subjects were compared with AN subjects not recovering menses and controls,menses recovered AN subjects had higher baseline cortisol levels and greater increases in leptin than controls and greater increases in fat mass than AN subjects not recovering menses and controls(adjusted for multiple comparisons). In a logistic regression model,increasing fat mass,but not leptin,predicted menstrual recovery. Baseline cortisol level strongly predicted increases in the percentage of body fat. We demonstrate that 1) high baseline cortisol level predicts increases in body fat and 2) increases in body fat predict menses recovery in AN.

Controversies in the treatment of digestive neuroendocrine tumors

Gastroenteropancreatic neuroendocrine tumors(NETs)have an incidence of 2.39 per 100,000 inhabitants per year,and a prevalence of 35 cases per 100,000 inhabitants;the gap between these rates is due to the relatively long survival time of these tumors,which can be thus considered as chronic oncological diseases.Recently,more therapeutic options have become available,but criteria for defining timing,priority and sequence of different therapeutic options are still debated.This review offers an overview of pancreatic and small bowel NETs,critically underlining the issues that still need to be clarified and some controversial issues on the therapeutic approach for NET patients.

Review of recent advances in medical treatment for neuroendocrine neoplasms:somatostatin analogs and chemotherapy

Neuroendocrine neoplasms(NENs)are a heterogeneous group of rare tumours often producing high levels of hormones and causing symptoms.There are a number of different types of NENs.They usually arise as advanced and low/intermediate grade only in a minority of cases,as high grade.Treatment depends on which type and may include surgery,interventional radiology,and systemic treatment,including chemotherapy,somatostatin analogs,interferonα2b,peptide receptor radionuclide therapy,and only for pancreatic neuroendocrine tumors,molecular targeted agents,including everolimus and sunitinib.The aim of the article is to review the medical approaches with somatostatin analogs and chemotherapy.The treatment of NENs is mainly based on their biological characteristics of aggressiveness and functional features,such as symptoms and endocrine markers.

Management of chronic hepatitis B during pregnancy

Chronic hepatitis B is globally prevalent and is a major cause of cirrhosis and hepatocellular carcinoma.Despite immunoprophylaxis against hepatitis B in pregnancy,perinatal transmission still occurs in at least 10%of the children born to a mother with high level of viremia.Decisions regarding hepatitis B therapy during pregnancy must take into account the benefits and safety for both the mother and the unborn baby.In this review,we summarize the current treatment options for chronic hepatitis B with a focus on management during pregnancy and the evidence-based strategies to prevent vertical transmission of hepatitis B virus(HBV).

An update on the management of chronic hepatitis D

Hepatitis D virus(HDV)infection is associated with severe liver-related morbidity and mortality.The prevalence of HDV is rising especially among people who abuse drugs and immigrants from endemic areas.Reliable diagnostic assays with enhanced sensitivity and specificity are essential for screening at-risk populations.Until recently,interferon has been the only treatment for hepatitis D.Its efficacy is,however,limited and it is associated with significant side effects.A number of novel antiviral agents that target various stages of the HDV life cycle show promising results.They are currently in different phases of clinical development.This review focuses on the changing epidemiology,novel therapeutic agents,and updated management of chronic hepatitis delta.

Analysis of the lower incidence of medullary thyroid cancer in China

To the Editor: Thyroid cancer, which is one of the most common diseases of the endocrine system, can be divided into four primary types, including papillary thyroid cancer (PTC) accounting for 80% to 90% of cases, follicular thyroid cancer accounting for 10% to 15% of cases, medullary thyroid cancer (MTC) accounting for 3% to 10% of cases, and anaplastic thyroid cancer accounting for 1% to 2% of cases. Typically, patients diagnosed with PTC or follicular thyroid cancer have better prognoses and overall survival rates than patients diagnosed with MTC or anaplastic thyroid cancer. The incidence of thyroid cancer has been rapidly growing in the world [Supplementary Figure S1, http://links.lww.com/CM9/A99].[1] During the last 20 years, China has experienced significant growth in the number of annual thyroid cancer diagnoses. According to the Dataset Records for National Central Cancer Registry of China, thyroid cancer incidences have steadily increased in China from 2010 to 2014, yet the mortality rate has remained stable during the same period [Supplementary Tables S1 and S2, http://links.lww.com/CM9/A99].

Interdisciplinary feeding clinic during the coronavirus disease 2019 pandemic:Implementing telehealth and social determinants of health screening

Pediatric feeding disorders(PFD)are an impairment in oral intake that are associated with nutritional,medical,psychosocial,or feeding skills dysfunction.1 They are clinically complex and challenging due to the heterogeneous underlying etiologies and significantly impact health and social-emotional development.2 Furthermore.

A call to action: Multi-disciplinary care and treatment of obesity in pediatrics

Pediatric obesity is the most prevalent chronic disease affecting 1 in 5 US children and is correlated with an increase in young patients diagnosed with obesity-related diseases.Early identification and treatment of childhood obesity is pivotal to slow or prevent progression of obesity and obesity-related diseases into adulthood.Current practice guidelines support a staged treatment approach to manage pediatric obesity with emphasis on multidisciplinary care in stages 3 and 4.^(1)