Emin ALTIPARMAK, Ahmet YOZGAT, Akif ALTINBAŞ

Gep-Net’lerde Endoskopik Tedaviden Karaciğer Nakline Uzanan Küratif ve Palyatif Tedavi Yöntemleri

Embriyolojik barsağın nöroendokrin hücrelerinden köken alan gastroenteropankreatik nöroendokrin tümör (GEPNET)’ler, ülkemizde sıklıkla mide ve ileum yerleşimlidir. İntestinal ve pankreatik NET’lerde tanı anında %77-91 oranında uzak metastaz varken, uzun dönem sağkalım bu hastaların G3 tümör olanlarında daha kötüdür. GEPNET’lerin histopatolojik özellikleri, örneğin mitoz sayısı ve Ki-67 indeksi, altta yatan hastalığın malignite potansiyelini yansıtmaktadır. Non-fonksiyone GEP-NET’ler fonksiyone olanlara göre daha geç tanı alırlar ve tanı esnasında da yüksek oranda metastatiktirler. Tedavide primer amaç, maksimum organ korunması ile birlikte lokal radikal rezeksiyondur. Bu derleme yazımızda GEP-NET’lere genel olarak tanı ve tedavide yaklaşımın nasıl olması gerektiği, GEP-NET’lerin yerleşim yeri göz önüne alınarak ülkemize ait veriler de dahil edilerek incelenmeye çalışılacaktır.

Curative and Paliative Treatment Modalities of Gep-Nets Varying From Endoscopic Therapy To Liver Transplantation

Gastroenteropancreatic neuroendocrin tumors (GEP-NET), which originated from neuroendocrin cells of embriologic gut, are frequently localized into stomach and ileum in our country. Distance metastasis were seen in 77-91% of ileal and pancreatic NETs, and long term survival is worse among G3 ones. Histopathologic features of GEP-NETs, e.g. freaquecy of mytosis and Ki 67 expression, present their own malignant potential. The functional capacity of underlying tumor seems to be important for its early or late diagnosis, and non-functional GEP-NETs may have more potential for distance metastasis. Primary aim for treatment should be local radical resection of tumors with maximum organ preservation. In this review article, with highlight of our own data, we aimed to discuss the management of GEP-NETs particularly based on its localization.

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