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Neuroendocrine Tumors (NETs) — Surgery Resection: treatment in the Best Hospitals in the World

Academic Hospital Brothers of Mercy Munich

10/10
location_onGermany, Munich

Department of General and Abdominal Surgery

The Department of General and Abdominal Surgery offers the full range of diagnostics and surgical treatment in these fields. The department's surgeons perform about 2,000 surgical procedures annually. The therapeutic options cover not only operations on the digestive tract and abdominal organs, but also surgical treatment for soft tissue traumatic injuries, removal of skin and thyroid tumors, including the partial removal. With appropriate clinical indications, the preference is given to minimally invasive techniques, which guarantee the patient minimal postoperative risks and speedy recovery. Also, the department’s scope of activities includes the installation of port systems for chemotherapy and parenteral nutrition.

Memorial Sisli Hospital Istanbul

9.2/10
location_onTurkey, Istanbul

Department of General and Bariatric Surgery

The Department of General and Bariatric Surgery offers the full range of effective surgical treatment at the highest level of modern medicine. The priority clinical tasks of the department's doctors include the surgical treatment of diseases of the abdominal organs, including the stomach, small and large intestine, liver, pancreas, gallbladder and biliary tract, as well as hernias and pathologies of the esophagus and thyroid gland. Of particular interest is colorectal surgery in patients with colon and rectal cancer, ulcerative colitis and Crohn's disease. In addition, the department's specialists provide treatment to the patients with morbid obesity. To quickly reduce body weight, the department performs gastric bypass surgery and sleeve gastroplasty. Such operations are performed in patients with a body mass index above 35, with the available complications of obesity. The department employs highly qualified surgeons who have successful clinical experience in performing operations of any degree of complexity.

University Hospital of Ludwig Maximilian University of Munich

10/10
location_onGermany, Munich

Department of General, Abdominal and Transplant Surgery

According to the Focus magazine, the Department of General, Abdominal and Transplant Surgery ranks among the best departments in Germany specializing in bowel cancer treatment! The department covers the full range of services in these medical fields and holds the leading position at the national and international level in terms of the number of surgical interventions performed and their success rate. Of particular interest are operations to treat cancer, organ transplants, as well as minimally invasive surgery.

Charite University Hospital Berlin

9/10
location_onGermany, Berlin

Department of General, Abdominal and Vascular Surgery

According to the Focus magazine, the Department of General, Abdominal and Vascular Surgery ranks among the top German medical facilities specializing in the treatment of bowel and lung cancer! The department offers all the modern surgical options for the treatment of diseases of the abdominal cavity and blood vessels. The department's doctors have expert knowledge and vast experience in the treatment of colorectal cancer, stomach, esophageal, pancreatic cancers, liver metastases, inflammatory bowel diseases (diverticular disease, Crohn's disease, ulcerative colitis). Also, they specialize in the surgical treatment of vascular pathologies and thyroid diseases.

University Hospital Ulm

8.7/10
location_onGermany, Ulm

Department of General and Abdominal Surgery

The Department of General and Abdominal Surgery offers the full range of surgical treatment of diseases of the esophagus and abdominal organs, thyroid and parathyroid glands, as well as the interventions in bariatric surgery. The surgeons of the department have a deep knowledge in all open and minimally invasive surgical techniques, perform extensive operations of high complexity with maximum safety for the patient.

Tel Aviv Sourasky Medical Center

9.9/10
location_onIsrael, Tel Aviv

Department of General Surgery

The Department of General Surgery offers the full range of surgical treatment for patients. It performs both planned and emergency surgical interventions. The department is the leading medical facility in Israel, whose surgeons regularly demonstrate outstanding treatment results. The surgical interventions are performed by experienced doctors who were trained in the most famous American Medical Centers. The department's specialists prefer sparing minimally invasive interventions, which significantly shorten the hospitalization period and minimize the risks of complications.

Medipol Mega University Hospital Istanbul

8/10
location_onTurkey, Istanbul

Department of General Surgery

The Department of General Surgery offers the full range of surgical treatment for various diseases. Of particular interest to the department's specialists is the treatment of cancer, particularly, stomach, pancreatic and bowel cancer. Another priority field is breast surgery, which includes the treatment of both benign and malignant diseases. In addition, the department's surgeons are proud of their successful experience in bariatric surgery and interventions on the endocrine glands. All operations are planned and carried out in accordance with the current international protocols.

Samsung Medical Center Seoul

9.8/10
location_onSouth Korea, Seoul

Department of Adult and Pediatric General Surgery

The Department of Adult and Pediatric General Surgery offers the full range of services in this medical field. The department specializes in gastrointestinal surgery, hepatobiliary surgery, colorectal surgery, breast surgery, endocrine, vascular and pediatric surgery. The department is equipped with the state-of-the-art equipment for performing laparoscopic, minimally invasive and robotic interventions that guarantee excellent treatment results.

University Hospital RWTH Aachen

9.2/10
location_onGermany, Aachen

Department of Adult and Pediatric General, Abdominal, Transplant Surgery

According to Focus magazine, the Department of Adult and Pediatric General, Abdominal, Transplant Surgery ranks among the top German medical facilities specializing in bowel cancer treatment! The department performs surgical treatment of general surgical diseases, abdominal pathologies, and also specializes in organ transplantation. Of particular interest are surgical oncology of the abdominal organs, as well as pancreatic and liver surgery. The department annually performs more than 3,000 surgical interventions, which contributes to its credibility at the national level.

University Hospital Marburg UKGM

8.6/10
location_onGermany, Marburg

Department of Abdominal, Thoracic and Vascular Surgery

The Department of Abdominal, Thoracic and Vascular Surgery offers all modern surgical interventions in these fields. Specialization covers the treatment of diseases of the abdominal organs, endocrine glands, pathologies of the lungs and chest wall, pathological vascular lesions of all parts of the body. In addition, kidney transplantation and pancreas transplantation are part of the surgeons' tasks. Whenever possible, operations are performed using minimally invasive techniques that have several advantages over classical interventions.

University Hospital Heidelberg

9.8/10
location_onGermany, Heidelberg

Department of General, Abdominal and Transplant Surgery

According to the Focus magazine, the Department of General, Abdominal and Transplant Surgery ranks among the top German departments specializing in bowel cancer treatment! The department offers the full range of services in these medical fields and guarantees the first-class medical care at the university level. The department specializes in the treatment of diseases of the abdominal cavity, esophagus and thyroid gland, transplantation of liver, kidney and pancreas. The medical facility has won the reputation of one of the three largest and most successful Transplant Centers in Germany. Also, within the clinical practice, doctors hold highly-specialized consultations on rare diseases and provide 24-hour emergency care. 

University Hospital Tuebingen

9.2/10
location_onGermany, Tuebingen

Department of General, Abdominal, Adult and Pediatric Transplant Surgery

According to the Focus magazine, the Department of General, Abdominal, Adult and Pediatric Transplant Surgery ranks among the top German departments specializing in the treatment of bowel cancer! The department specializes in the treatment of tumors of the gastrointestinal tract, pancreas, liver, and retroperitoneal space (peritoneal carcinomatosis), liver, kidney, pancreas, bowel transplantations in children and adults, as well as the surgical treatment of obesity and general surgical interventions.

University Hospital Rechts der Isar Munich

9.8/10
location_onGermany, Munich

Department of Surgery

The Department of Surgery offers the full range of services in this field and specializes in general, abdominal, thoracic, transplant surgery. The medical team of the department, consisting of 10 specialized senior physicians, 30 medical specialists and assistant physicians, as well as highly motivated nursing staff, provides first-class treatment of tumors, inflammatory and degenerative diseases of the esophagus, stomach, intestines, pancreas, liver, gallbladder, spleen, lungs, thyroid and parathyroid glands. The department is headed by Prof. Dr. med. Helmut Friess.

University Hospital Duesseldorf

9.5/10
location_onGermany, Duesseldorf

Department of General, Abdominal and Pediatric Surgery

The Department of General, Abdominal and Pediatric Surgery offers the full range of surgical treatment of diseases of the organs of abdominal cavity, thorax, emergency surgical care in polytrauma, as well as many surgical interventions in children. Of particular interest is cancer surgery on the liver, gallbladder, and pancreas. In addition, the department's specialists masterfully manage all the methods of bariatric surgery. Many operations are performed using minimally invasive techniques, which facilitate the quickest possible recovery of the patient.

University Hospital Erlangen

9.1/10
location_onGermany, Erlangen

Department of General and Abdominal Surgery

According to the Focus magazine, the Department of General and Abdominal Surgery ranks among the top German departments specializing in bowel cancer treatment! The department offers the full range of modern surgical treatment. The clinical priority is cancer surgery, especially sparing, minimally invasive procedures and high-precision robot-assisted interventions. Each patient receives an individually adapted treatment regimen, which is discussed at daily conferences with doctors from related disciplines. Particular attention is paid to the comprehensive counseling, including on non-operational, traditional treatment methods.

University Hospital Saarland Homburg

9.8/10
location_onGermany, Homburg

Department of General, Abdominal, Vascular and Pediatric Surgery

The Department of General, Abdominal, Vascular and Pediatric Surgery covers the full range of services in these medical fields. Surgical treatment is provided   both on an inpatient and outpatient basis, in accordance with the advanced recommendations of professional societies. The department is equipped with state-of-the-art operating theaters, in which surgeons perform extensive serious interventions, operations under the control of navigation systems and high-precision minimally invasive procedures that ensure the rapid recovery of patients.

Neuroendocrine tumors (NETs) are a group of cancerous formations that can be located in different parts of the body. The most common localization of neuroendocrine tumors is the lungs and gastrointestinal tract.

Overview

Neuroendocrine tumors (NETs) develop from neuroendocrine cells present in various organs and systems. They produce hormones and biologically active peptides. Most neuroendocrine tumors grow slowly and do not show any clinical symptoms for a long time. But there are also aggressive types of neuroendocrine tumors with significant hormonal activity. All neoplasms of this type are prone to invasion and metastasis.

Neuroendocrine tumors (NETs) are neoplasms capable of synthesizing biologically active substances, the source of which is cells of the diffuse endocrine system.

NETs of the digestive system, according to various statistics, are detected with a frequency of about 12 – 15 patients per 1 million population. Among them, pancreatic neoplasms are found in about 70–80% of patients. The NETs of the pancreas, along with tumors of the lungs, bronchi, gastrointestinal tract, kidneys, and skin, account for less than 1% of all malignant tumors. Even large clinics rarely have the experience of treating more than about 100 patients with neuroendocrine tumors.

According to the statistics, in about 65–70% of patients, functioning NETs are isolated, which produce one or more biologically active substances that determine the corresponding clinical picture. In most cases, patients with NETs may develop severe clinical symptoms and pathological conditions caused by the hormonal activity of these tumors, such as hypoglycemic disease, Zollinger-Ellison syndrome, Werner-Morrison syndrome, and some other pathological conditions.

Besides, the development of some of these syndromes can be caused not only by a neoplasm of the pancreas but also by NETs of other localization – stomach or duodenum. In the case of a timely diagnosis and medical treatment with radical surgery, satisfactory results of therapy in the form of a 5-year survival rate is about 80 – 100%, and cytoreductive intervention is about 40 – 60%.

Risk factors

The reasons for the development of pathologies are unknown. Risk factors, however, for the development of the disease are:

  • Hereditary syndromes (multiple endocrine neoplasia types 1 and 2), Von Hippel-Lindau syndrome, type 1 neurofibromatosis)
  • Patients of older age-group (the disease is rarely diagnosed in children and adolescents)
  • Female patients (pathology is more common in women)

There are no data on the negative impact of diet, bad habits, and environmental factors on the development of the disease.

Types

Depending on the location there are several types of neuroendocrine tumors including:

  • Gastroenteropancreatic neuroendocrine tumors (more than half of all cases)

They include neoplasms of the stomach, duodenum and small intestine, appendix, various parts of the large intestine, and pancreas.

  • Bronchopulmonary neuroendocrine tumors – typical and atypical lung carcinoid, small cell carcinoma, large cell neuroendocrine carcinoma (about 25-30%)
  • Extrapulmonary small cell carcinomas
  • Pituitary neuroendocrine tumors (located in front of the neuroendocrine gland)
  • Hepatic neuroendocrine tumors
  • Pheochromocytoma
  • Neoplasms of the peripheral nervous system (schwannomas, paragangliomas, neuroblastomas)
  • Genitourinary system tumors (neuroendocrine cancer and carcinoid of the urinary tract, neuroendocrine tumors of the ovaries, cervix, prostate, and testicles)
  • Merkel cell carcinoma

According to hormonal activity, neoplasms are divided into:

  • Insulinomas
  • Glucagonomas
  • Gastrinomas
  • Somatostatinomas

Most of the tumors listed above are located in the pancreas.

Stages

There are 4 stages of development of neuroendocrine tumors:

  • Stage 1

Stage 1 of neuroendocrine cancer includes primary neuroendocrine tumor up to 2 cm in diameter; lymph nodes are not affected.

  • Stage 2

In the second stage, the size of the formation exceeds 2 cm, but does not spread to other tissues or lymph nodes; at the advanced second stage, the process involves nearby connective tissues, muscles, cartilage, and bones without affecting the lymph nodes.

  • Stage 3

In the third stage, the neuroendocrine tumor has spread to lymph nodes, adjacent cartilage, bones, muscles, connective tissues.

  • Stage 4

During the fourth stage, metastases from the tumor are found in the liver, lungs, brain, and bones.

Symptoms

The symptoms that patients with neuroendocrine tumors experience depend, first of all, on the type of hormones produced by the tumor. Most often with the serotonin production, patients experience:

  • Hot flashes
  • Telangiectasia (a condition in which widened venules cause threadlike red lines or patterns on the skin)
  • Shortness of breath, wheezing, and cough associated with bronchospasm
  • Diarrhea (sometimes up to 10-15 liters per day)
  • Weight gain
  • Tachycardia
  • Murmurs (produced when blood is pumped across a heart valve and creates a sound loud enough to be heard with a stethoscope) when listening to the heart
  • Hypertension and low blood pressure
  • Fibrous changes in the endocardium
  • Signs of stagnation in the pulmonary circulation (cough, shortness of breath, pulmonary edema)

In stressful situations, after anesthesia or surgery, a carcinoid crisis may develop. It is caused by a significant release of serotonin. It is manifested by sudden changes in pressure, tachycardia, severe diarrhea, and pronounced redness of the face. The condition is of a medical emergency. With insulinoma, the following symptoms can manifest:

  • Tremor
  • Convulsions
  • Nervousness
  • Weakness
  • Sweating
  • Dizziness
  • Fainting
  • In severe cases, coma

Diagnostics

The diagnosis of neuroendocrine tumors (NETs) and treatment of the disease in the form of radical operations can only be performed after the confirmed diagnosis.

Laboratory research begins with general clinical tests, and if the diagnosis is not clear based on the results, studies of the levels of certain hormones or their metabolites are prescribed.

Many neuroendocrine tumors are very small and it is really difficult to identify their location.

In European hospitals, patients with suspected neuroendocrine tumor undergo:

  • Endoscopic examination of the gastrointestinal tract, if suspicious formations are detected, a biopsy is taken for histological examination
  • Abdominal ultrasound
  • Chest X-ray to visualize the formation
  • CT or MRI of various parts of the body (special contrast agents are used)
  • Positron emission tomography (PET) allows the accumulation of isotope-labeled glucose to identify even the smallest fast-growing tumor foci

Treatment

Resection is a surgery that completely removes the neuroendocrine tumor along with some healthy tissue nearby. Resection is the main medical treatment for most NETs that haven’t metastasized yet.

Surgery resection of NETs implies either the removal of the neoplasm itself within healthy tissues or (in the case of serious damage) the radical surgery resection of the entire organ. Often, nearby lymph nodes are also excised. In most cases, surgery resection for neuroendocrine tumors has a favorable prognosis.

Before surgery resection, beyond measures of the diagnosis patients usually undergo:

  • Clinical and biochemical blood tests
  • Assessment of the functional parameters of the liver and kidneys
  • A study of the concentration in the blood of tumor markers
  • Assessment of the work of the blood coagulation system
  • Testing for syphilis, HIV, hepatitis B and C
  • Determination of blood group and Rh factor
  • General and biochemical urine tests
  • Determination of the concentration of serotonin in the blood
  • Urine analysis for metabolites (5-HIAA)
  • Assessment of the concentration of pancreatic hormones that are capable of producing tumor cells (somatostatin, insulin, vasoactive intestinal peptide, glucagon, gastrin)
  • Biopsy of a suspicious area with further histological examination of the material obtained

During surgery resection for the treatment of patients with NETs, it is extremely important to ensure that all malignant cells have been removed. For this, a tissue site that is affected by a tumor is removed and sent for express analysis to a laboratory. There, a specialist examines the edges of the tissue under a microscope. If the surgery resection is successful, only healthy cells should remain. This means that the neuroendocrine tumor of the lung, stomach, intestine, pancreas, or other organ has been completely removed.

In patients with an advanced stage of tumor development, a surgery resection may be considered inappropriate. In this case, cytoreductive intervention is sometimes performed in European hospitals, the purpose of which is to minimize the volume of tumor tissue in the patient’s body. Further, reserved radiation therapy and modern schemes of specific pharmacological drugs (including targeted therapy and immunotherapy) are considered possible additional therapeutic techniques for patients with NETs.

Among the minimally invasive operations, it is worth noting radiofrequency ablation and embolization of the arteries that feed the neoplasm. Such interventions demonstrate the best results in patients with neuroendocrine liver tumors.

After surgery resection of a neuroendocrine tumor, the patients are under the supervision of doctors. The length of stay (from 1 to 14 days) depends on the scale of the operation and the presence or absence of postoperative complications in patients.

The prognosis of the treatment is largely determined by the organ in which the neoplasm was detected, as well as at what stage of tumor development the treatment was started. If the spread of malignant cells has not yet begun and the surgery resection was performed on time, then, according to statistics, a 5-year survival rate is observed in about 92% of patients. The age of patients and the general state of health also play a role in determining the prognosis.

After discharge from the hospital, the patients are recommended systematic observation. Patients must attend preventive examinations with an oncologist every 3 months during the first two years after the operation and once every six months thereafter.

Side effects can happen with any type of treatment for NETs, but everyone’s experience is different. Some patients have multiple side effects; other patients have only a few side effects.

Side effects can develop any time during, immediately after, or a few days or weeks after the surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.

Side effects of surgery for NETs treatment will depend mainly on the type of surgery, resection area in the body, and patient’s overall health condition.

Where can I undergo treatment with surgery resection abroad?

Health tourism becomes more and more popular these days, as medicine abroad, often ensures a much better quality of medical treatment with surgery resection.

The following European hospitals show the best success rates in medical treatment with surgery resection:

  1. Academic Hospital Brothers of Mercy Munich, Germany
  2. Memorial Sisli Hospital Istanbul, Turkey
  3. University Hospital of Ludwig Maximilian University of Munich, Germany
  4. Charite University Hospital Berlin, Germany
  5. University Hospital Ulm, Germany

You can find more information about the European hospitals on the Booking Health website.

The cost of treatment with surgery resection

The prices in European hospitals listed on Booking Health are relatively low. With Booking Health, you can undergo medical treatment with surgery resection at an affordable price.

The cost of treatment varies, as the price depends on the hospital, the specifics of the disease, and the complexity of its treatment.

The cost of treatment with surgery resection in Germany is 18,602 – 30,583 EUR.

The cost of treatment with surgery resection in Turkey is 12,424 – 15,466 EUR.

You might want to consider the cost of possible additional procedures and follow-up care. Therefore, the ultimate cost of treatment may differ from the initial price.

To make sure that the overall cost of treatment is suitable for you, contact us by leaving the request on the Booking Health website.

How can I undergo treatment with surgery resection abroad?

It is not easy to self-organize any treatment abroad. It takes certain knowledge and expertise. Thus, it is safer, easier, and less stressful to use the services of a medical tourism agency.

As the largest and most transparent medical tourism agency in the world, Booking Health has up-to-date information about the treatment with surgery resection in the best European hospitals. We will help you select the right clinic taking into account your wishes for treatment.

We want to help you and take on all the troubles. You can be free of unnecessary stress, while Booking Health takes care of all organizational issues regarding medical treatment. Our services aimed at you safely and successfully undergoing treatment with surgery resection.

Medical tourism can be easy!

All you need to do is to leave a request on the Booking Health website and our manager will contact you shortly.




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