Our Summary

This research paper looks at how a technique called fluorescence angiography (FA) can be used in surgery for small bowel neuroendocrine neoplasms (SB-NEN), which are a type of tumor. The surgery can sometimes cause issues with blood flow in the remaining bowel because it involves removing lymph node metastases (cancer that has spread to the lymph nodes) that are close to important blood vessels. FA uses a substance called indocyanine green to check blood flow during the surgery.

The study looked at ten patients who had surgery for SB-NEN. All had cancer that had spread to the lymph nodes near important blood vessels. The use of FA changed how the surgery was performed in eight out of the ten patients. In four of these patients, less bowel was removed than planned, with 5-35 cm preserved. In the other four, more bowel was removed, with an extra 3-25 cm taken out.

The average stay in hospital after surgery was four days. No patients had any leakage from the place where the bowel was sewn back together after surgery.

This is the first study of this kind and it found that FA can help doctors decide how much bowel to remove during surgery for SB-NEN. It helps them to either save more of the bowel or to remove parts that are not getting enough blood flow.

FAQs

  1. What is fluorescence angiography (FA) and how is it used in surgery for small bowel neuroendocrine neoplasms (SB-NEN)?
  2. How did the use of FA influence the amount of bowel removed during surgery in the study?
  3. What was the average hospital stay for patients after undergoing the surgery in this study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about bowel resection is to follow post-operative care instructions carefully, including taking prescribed medications, eating a healthy diet, staying hydrated, and avoiding strenuous activities until fully healed. It is also important to attend follow-up appointments with your healthcare provider to monitor your recovery and address any concerns.

Suitable For

Patients who are typically recommended bowel resection include those with small bowel neuroendocrine neoplasms (SB-NEN) that have spread to the lymph nodes near important blood vessels. These patients may benefit from surgery that involves removing lymph node metastases, but this can sometimes affect blood flow in the remaining bowel. The use of fluorescence angiography (FA) can help guide surgeons in determining how much bowel to remove during the surgery, potentially saving more of the bowel or removing parts that are not receiving enough blood flow.

Timeline

Before bowel resection:

  • Patient is diagnosed with small bowel neuroendocrine neoplasms (SB-NEN)
  • Surgery is recommended to remove lymph node metastases near important blood vessels
  • Patient undergoes pre-operative assessments and preparation for surgery

During bowel resection:

  • Fluorescence angiography (FA) is used during surgery to check blood flow in the remaining bowel
  • FA helps surgeons determine how much bowel to remove
  • Surgery is performed to remove lymph node metastases and part of the small bowel affected by cancer

After bowel resection:

  • Patient stays in the hospital for an average of four days post-surgery
  • Patients do not experience leakage from the bowel after surgery
  • Follow-up appointments and monitoring may be required to assess recovery and potential complications

Overall, the use of FA during surgery for SB-NEN can help personalize the surgical approach and improve outcomes for patients undergoing bowel resection.

What to Ask Your Doctor

Some questions a patient should ask their doctor about bowel resection for SB-NEN include:

  1. How will the surgery affect my bowel function and quality of life?
  2. What are the potential risks and complications associated with bowel resection for SB-NEN?
  3. Will I need a temporary or permanent colostomy or ileostomy after the surgery?
  4. How long is the recovery process and what can I expect in terms of pain management?
  5. Will I need any additional treatments, such as chemotherapy or radiation therapy, after the surgery?
  6. How often will I need follow-up appointments and monitoring after the surgery?
  7. How experienced are you in performing bowel resection surgeries for SB-NEN, and what is your success rate?
  8. Will the use of fluorescence angiography be considered during my surgery to assess blood flow in the remaining bowel?
  9. What changes should I make to my diet or lifestyle after the surgery?
  10. Are there any support groups or resources available for patients undergoing bowel resection for SB-NEN?

Reference

Authors: Kaçmaz E, Slooter MD, Nieveen van Dijkum EJM, Tanis PJ, Engelsman AF. Journal: Eur J Surg Oncol. 2021 Jul;47(7):1611-1615. doi: 10.1016/j.ejso.2020.12.008. Epub 2021 Jan 19. PMID: 33353827