Introduction: Maintaining adequate nutritional status can be a challenge for patients with small intestinal neuroendocrine tumours (NETs) and mesenteric lymph node metastasis which can form a mesenteric mass. The preferred treatment option would be resection of this mesenteric mass, however, due to adjacent small bowel loops there is a risk of developing short bowel syndrome (SBS). If the mesenteric mass is not resected there is a risk of developing inoperable malignant bowel obstruction (IMBO) or ischemia. SBS and IMBO are forms of intestinal failure (IF) wherein home parenteral nutrition (HPN) could be considered to maintain patients nutritional status. One of the concerns regarding HPN is to develop life-threatening septicaemia due to catheter-related bloodstream infection. HPN is widely established in patients with non-NET cancers and supported by guidelines, but it is rarely considered for patients with small intestinal NETs. There exists limited data regarding the use of HPN in patients with small intestinal NETs.
The aim: To summarize existing literature and to create more awareness for HPN in patients with small intestinal NETs.
Methods: A systematic review was performed regarding patients with small intestinal NETs and IF to report on overall survival and HPN-related complications and create awareness for this treatment.
Results: Five articles regarding patients with small intestinal NETs or a subgroup of patients with NETs could be identified, mainly case series with major concerns regarding bias. The studies included 60 patients (range 141), 26 males and 34 females, with median age 63-72 year. All studies included patients with SBS and 4 studies included patients with IMBO. The overall survival time varied between 0.5 and 154 months on HPN. However, 58% of patients were alive 1 year after commencing HPN. The reported catheter-related bloodstream infection rate was 0.642 per 1000 catheter days.
Conclusion: This systematic review demonstrates the feasibility of the use of HPN in patients with NETs and IF in expert centres with a reasonable 1-year survival rate and low complication rate. Further research is necessary to compare patients with NETs and IF with and without HPN and the effect of HPN on their quality of life.