Neuroendocrine Tumor Surgery

Man using hospital monitor Surgery frequently plays a central role in the management of neuroendocrine tumors (NETs). Like other tumors, the goal is to remove NETs in an attempt to provide a cure whenever possible. But even when NETs have metastasized (spread), surgery may still provide a significant benefit.

Surgical options are influenced by a number of factors, including type of NET, size, location and extent of disease. At Penn Medicine, our specialized NET surgical team has extensive experience with a broad range of approaches. We give you the best chance at effective care, regardless of the situation. While we take on challenging cases, we always ensure there’s a good reason to operate. We carefully weigh the risks and benefits with you. Surgery may provide an option for:

Gastrointestinal (GI) NETs
Lung NETs
Pancreatic NETS
Pheochromocytomas and paragangliomas (pheo-paras)

Why Choose the Abramson Cancer Center for Neuroendocrine Tumor Surgery?

Our team performs a high number of surgeries for NETs each year, relative to how often they occur. We offer the experience and range of options you need for these complex and uncommon tumors. We also take a collaborative and selective approach that balances the potential benefits and surgical risk.

When you come to our program, you’ll find:

Safety: Our entire team has years of operating room experience with NETS, from our surgeons to our nurses and anesthesiologists. We know how to manage challenging scenarios during surgery, such as swings in blood pressure from pheo-paras and carcinoid syndrome with GI and lung NETs. Learn more about our neuroendocrine tumor team.
Expert collaboration: Even when they’re removable, NETs require a range of expert care. Our team gathers weekly to thoroughly review cases and make treatment recommendations. Many of our specialists are national and international experts in NET management. They regularly publish leading research papers and sit on national committees that create treatment guidelines.
Support: A nurse navigator or nurse coordinator arranges your appointment and is always ready to help with any need. We provide gastrointestinal management for NET symptoms and side effects, as well as a wide range of other NET support.

Surgery to Completely Remove NETs

When making treatment recommendations for a neuroendocrine tumor, we determine early on if we can completely and safely remove it. Surgeons call this removal of tissue resection, and it may sometimes require removing an organ or a gland.

Looking to surgical removal first provides the best possibility of a cure, assuming the tumor is localized (not yet spread beyond nearby lymph nodes). Remaining NET cells may cause disease to eventually return. This is a possibility we watch for. Surgery also relieves symptoms and stops hormone release, a feature of many NETs. It may provide all the treatment you need.

Even if tumors have turned cancerous and spread, removing all the disease may still be possible. For example, if a pancreatic NET has spread to a limited number of spots in the liver, we may still operate on both the pancreas and the liver. This approach differs from many other cancers — it’s not usually the approach when more common pancreatic cancers spread, for example.

Our approach to surgery also includes:

Minimally invasive techniques: When possible, our surgeons take a minimally invasive approach, with smaller incisions. This method usually means a shorter hospital stay and faster recovery. For lung NETs, we remove as little tissue as safely possible, to protect lung function. For pheochromocytoma, some uncommon genetic changes can lead to tumors in both adrenal glands. We can perform surgery to spare gland tissue (cortical sparing adrenalectomy).
Follow-up therapies: Removable NETs typically don’t require additional treatment right after surgery. However, we may follow up with chemotherapy, radiation therapy or both for tumors that are poorly differentiated. That distinction means their cells look very different than normal cells.
Alternatives: Some paragangliomas sit too close to head and neck nerves for removal. We can use radiation therapy to treat such tumors while protecting those nerves. For other tumors, we occasionally combine treatments, such as surgery for the main tumor and ablation for metastatic spots. Ablation burns or freezes tumors.

Debulking NETs with Surgery

Even when we can’t remove all the disease, surgery can still play an important role. With a single large tumor, we can reduce its size as much as we can. With multiple tumors, we take out as many as we can. This approach can reduce hormone release, provide better long-term disease control and lessen symptoms. It can also prevent complications and make other treatments more effective and easier to tolerate.

We commonly use debulking on the liver when tumors have metastasized there; we also occasionally use it in other locations. If we can remove most of the disease in the liver, we can set the clock back significantly in how cancer has progressed. We can also potentially put off therapies that could prove harder on the liver.

Learn more about liver-directed therapy for NETs, including how we decide between liver debulking and other options.

Surgically Removing Primary NET Tumors With Metastatic Disease

Even when metastatic disease is not removable, taking out the original tumor can still provide benefits, especially in the GI tract. If safely possible, we’re committed to finding and removing these primary tumors, a step not all programs take. If primary intestinal tumors are left in place, over time they can block the GI tract, continue releasing hormones, form additional metastases or (less often) cause bleeding.

We may wait to take out the primary tumor until we have met other, more pressing needs, such as treating the liver. While we mainly take out primary tumors in the intestines, we may occasionally recommend doing so in other areas, such as the pancreas.

Other NET-Related Surgeries

We may sometimes recommend additional surgeries, even when there is no disease present:

With some pheochromocytomas driven by inherited genetic mutations, we may also recommend taking out the thyroid gland because of the risk of other tumors.
Somatostatin analogs, a common NET drug therapy, can cause gallstones to form. We may recommend taking out the gallbladder as a precaution if you’re undergoing other surgery.

Learn more about drug therapy for NETs.