Surgical management of small intestinal neuroendocrine tumours ➡️ doi.org/10.1093/bjs/znag016 I TNE dell’intestino tenue richiedono un approccio chirurgico specifico, in grado di conciliare controllo oncologico, preservazione della funzione intestinale, sollievo dei sintomi e qualità di vita a lungo termine Questa Commission BJS sottolinea l’importanza di una presa in carico multidisciplinare, con expertise nei TNE, e la necessità di strategie più standardizzate e basate sulle evidenze lungo tutto il percorso perioperatorio Lavoro di Julie Hallet , Massimo Falconi , Sean Bennet , Andrea Frilling , Alexandra Gangi , Sébastien Gaujoux , Rodney Pommier , Emilio Bertani , Gabriela A Buerba , Jennifer Chan , Callisia N Clarke , Sophie Deguelte , Jaydira Del Rivero , Els Nieveen van Dijkum , Teodora Dumitra , Dilmurodjon Eshmuminov , Anton Engelsman , Francesca Fermi , Simona Grozinsky-Glasberg , James R Howe , Angela Lamarca , Léamarie Meloche-Dumas , Frédéric Mercier , Sten Myrehaug , Julie Perinel , Charles De Ponthaud , Ville Sallinen , Yun Song , Heather Stuart , Eva T Janson , Pascale Tinguely , Francesca Tozzi , Tessa van Ginhoven , Susanne Warner , Kjetil Soreide , @spartelli #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide #some4UGI #uppergi #esophagealcancer #gastriccancer #reflux @ISDE_net @Augishealth @roux_group @T4UGIS @SARONG_Trial @YoungIFSO #bariatricsurgery

🦇Holy survival curve Batman @nejm ahead of #ASCO presentation Daraxonrasib 🆚 chemo, pretreated PDAC #RASolute302 📈OS 13.2 vs 6.7 mo, HR 0.40 📈PFS 7.2 vs 3.6 mo ✅ Rx discontinuation 1.2% vs 11.2% 🔥 Big day in pancreatic cancer Now let’s get this to periop setting? 😁

Risk factors for death <12 months from surgery for #pancreaticancer after #neoadjuvant treatment in @AnnSurgOncol ➡️11% in 418 pts from @SanRaffaeleMI 💥predictors: preop size>25 mm & CA19-9>100 🏆external validation: 473 pts from @PancreasVerona link.springer.com/article/10…

Are you involved in the treatment of neuroendocrine tumors (NETs)? We invite you to take part in a short survey exploring current clinical practice and perspectives on Peptide Receptor Radionuclide Therapy (PRRT). 👉 Participate here: myredcapstack26.eu-west-1.el…

🏥Verona, Ancona, Milan since 2015. ✈️A journey built alongside Massimo Falconi, shared with @StefanoCrippa6 🤝These results tell a true story of teamwork 💪Proud to be part of it @SanRaffaeleMI

😅😅😅😅 same exact situation in today’s Whipple. Hypertrophic pancreatoduodenal artery in close proximity to the NET. Did not picture it, though 😔

🦓Pancreatic NETs are often highly vascular. A prominent pancreatoduodenal artery highlights this feature. 👉 The NET paradox: more vascularization ≠ more aggressiveness. Well-differentiated PanNETs tend to be more angiogenic, while aggressive forms often lose this pattern.

✨2️⃣0️⃣2️⃣5️⃣Review:🔝10 papers that impacted my practice & research 3⃣Criteria for high-risk PanNETs: combination Ki-67 ≥ 5%, enlarged LN, venous thrombosis associated w early recurrence by @spartelli ⚠️Consider systemic therapy for those tumors

Risk of post-op diabetes after DP for localised NF-PanNET 🚨41% develop diabetes Pre-op predictors: 📏 Distal healthy parenchyma ⚖️ BMI 🍬 HbA1c 🔮nomogram + online calculator supporting 🪡 prehabilitation & parenchyma-sparing strategies @spartelli authors.elsevier.com/c/1m3nL…

Perioperative therapy to advance care of high-risk PanNETs @CUTNETs_ @SocSurgOnc session at #NANETS25 Highlights🧵👇🏻 1️⃣Therapy options💊- Dr A Phan 2️⃣Defining high-risk PanNETs🎯 @spartelli 3️⃣Combination therapy for liver mets🔪 @JMaxCutsNETs 4️⃣Bridging gap with trials⏭️

Great to see MCW well represented at @NANETS1 2025. @MCWSurgery @MCWCancerCenter @mellowescenter

🦓 💯KEY HIGHLIGHTS from Dr Singh's talk on NET year in review: 💊 Therapeutics: - COMPETE trial- Lu177-Edotreotide with superior PFS compared to everolimus in GEPNETs @Ja_Capdevila -OCLURANDOM- Luthathera with improvement in response rate and PFS compared to sunitinib in pNETs (both showing PRRT better than targeted therapies- should be sequenced before targeted therapies) -CABINET- published in NEJM and cabozantinib approved for progressive NETs. New QoL data- no deterioration. -ALPHAMEDIX02-Phase 2 Pb212-DOTAMTATE active in RLT naive and RLT-exposed NETs. RLT-naive- ORR 60% and 36 month PFS 72%. RLT-exposed ORR 34%, 18-month PFS-83%. Concern for dysphagia!! Concern for renal toxicity as well. -Pb212-VMT alpha NET: Early data- promising ORR (35%) and no major AEs. Especially no dysphagia. #ESMO25 @OncoThor -RETNET trial- Chemo vs bland embolization- similar for hepatic PFS and extra-hepatic PFS. Carcinoid symptom control similar, more AEs with bland. -LITESPARK-015 (@Ja_Capdevila)- belzutifan in pNETs- ORR 10%, mPFS 3.9 months. gVHL --> durable responses (already FDA approved)- perhaps limit use to only these patients for now. - STARTER NET- everolimus vs lanreotide+everolimus. Results quite puzzling- not practice changing, control arm not appropriate per NA standards. - Pazopanib in extrapancreatic NETs- Bergsland et al. signal of activity but high AEs. Limited clinical relevance. - Lu177 DOTATATE- in advanced pheo/para (JCO 2025)- Phase II- mPFS 19.9 months, 17% catecholamine release syndrome. SDHx- benefit relatively lesser. - Cabo+atezo: open label phase 2. 6 cohorts across sites of origin. (@Ja_Capdevila et al) ORR 16.7% in GEP-NETs. Not practice changing for now. - CTLA4 and PD-1 (DART) in pNETs- JITC 2025- some responses, but overall benefit limited. - AveNEC trial- another negative study, demonstrating limited role of ICI in extra-pulm NENs. -LBL-024 (4-1BB, PD-L1) in combination with EP in NECs- ORR 75%, DCR 92.3%. ASCO 25. - Obrixtamig in extra-pulmonary NEC (epNEC) by @Ja_Capdevila et al- ORR 40% in DLL3-high, only 3% in DLL3-low. Promising results for DLL3-high. -NORDIC NEC2 study- ORR 30%. 20-40% immediate progression. Poor PS, Ki67 >55%, female sex: worse outcomes. Labor of love by Sorbye et al. 🔪 Surgery: -Partelli et al- borderline resectable pNETs- Tumors>3 cm, Ki67>5%, tumor VTE- poorer outcomes. - Moonen et al, Modern Pathology 2025- Dutch registry. IHC risk stratification panel predicting outcomes with resection of lung NETs. - Tslimigras et al ASO 2025- mesoappendiceal invasion does not predict benefit of hemicolectomy in appendiceal neoplasms. - Dumas et al ASO 2025- Metastatic NETs- ?surgery better than liver directed therapy for liver metastases?- more AEs with embolization. 🚀Other: - Chan et al. JNM 2025- MTV (metabolic tumor volume) on FDG PET- predicts outcomes and SUVmax does not. - BEND2 fusions- predictor of outcomes in pNETs. Wood Trageser et al Modern Pathology 2025. - DLL3 data- expression across sites of origin, include WD G3. @rohit_thum et al (in press) pre-print on med Rxiv 2025. - Gudmundsdottir et al @MayoClinic - regardless of Ki67- ALT+ resected WD pNETs did worse. ALT may be included in risk models? J Neuroendocrinol 2025 -Patte et al. SBNETs 4 molecular subtypes (vesicular, epithelial, immune and mesenchymal)!! @Nature Communications 2025 -Ji et al. Cancer Cell 2025- proteomic subtypes of non functional pNETs. -Sukrithan et al- WGS in NENs- JNCCN 2025- high prevalence of P/LP alterations. Guidelines: - ASCO symptom management: JCO Oncol Practice 2025 -MEN1 guideline- Lancet Endocrinol 2025 #NANETS25 @helops79 @NVijayvergiaMD @AmanChauhanMD @HalletJulie @SethConcorsMD @ChandrikhaC @spartelli @GIMedOnc @TheGutOncLab @PoHienEar @DraMartinezLago

Honored to have served as Visiting Professor at the Surgical Oncology Division, @UTSWMedCenter Truly impressed by the team’s passion, precision, and excellence in robotic pancreatic surgery Grateful to @AdamYopp and @PatricioPolanc0 for the opportunity and warm hospitality 🙏

📢 Small NF PanNETs can/should be observed #ASPEN🏔️ @spartelli #ESMO25 👥Prospective multi-centre cohort 1️⃣0️⃣0️⃣0️⃣ PanNETs <2cm An image 🏞️ is worth 1000 words👇🏻 For resection: 😳NNT 276 ⚠️NNH 6 ✅No difference in OS surgery vs active surveillance 👏Congrats on landmark work!

To operate or not on panc NETs <2 cm…? The answer is NOT. Excellent presentation by @spartelli on the long term outcomes of the ASPEN trial. Almost 1000 patients observed w/o resection and progression was uncommon, mets rare and survival the same as with resection.

@spartelli presents at #ESMO25 main results of ASPEN study. Surgery vs Surveillance in <2cm PanNETs ✅️18.5% of patients had surgery in the FUP group. ✅️No differences in survival. ✅️Rutine surgery is not justified.

🌎 expert consensus statement on perioperative management of carcinoid crisis at #ESSO44 by Dr Luana Genova - thanks for presenting! 🔄 Shift away from routine octreotide ❌not necessary as prophylaxis 🔑 treat intraop crisis treatment quickly with pressors @spartelli

Excited to present at #ESMO2025 the results of the ASPEN study on 1,000 patients with pancreatic NETs <2 cm. What do you think the data will support? Surgery 🔪 or observation 🔭 @myESMO