New Surgical Strategies

The incidence of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) has significantly increased over the last three decades. Surgery is the mainstay for their management as it represents the only possibility of reaching a definitive cure. GEP-NENs are characterized by a high level of heterogeneity, in terms of both clinical presentation and disease aggressiveness. Therefore, their surgical treatment should be tailored taking into account tumor and patient’s features. A surveillance strategy has been advocated for the management of incidentally discovered, asymptomatic, small lesions without radiological or endoscopic features of malignancy. On the other hand, formal resections associated to lymphadenectomy are the gold standard for patients with localized GEP-NENs for whom a conservative strategy is not feasible. Finally, surgery may play a role even for selected patients with metastatic or high-grade well-differentiated neoplasms, who could benefit from this strategy. Therefore, surgery should be included in a multimodal treatment approach for patients with advanced GEP-NENs.