Midgut Neuroendocrine Tumours: Are They at Higher Risk of Anastomotic Leak Than Midgut Adenocarcinomas? A Case–Control Study

Background: The incidence of neuroendocrine tumours is increasing; they are now the most prevalent small bowel malignancy.

Aims: To identify whether primary anastomoses following resections of midgut neuroendocrine tumours (NETs) are at higher risk of anastomotic leak than primary anastomoses following midgut adenocarcinoma resections. Methods and

Results: Retrospective analysis of all cases of midgut NET resections and primary anastomoses at a tertiary university hospital in the UK 2019–2024, comparing these to controls of midgut adenocarcinoma resections and primary anastomoses at the same hospital during the same time period. 35 NET cases were matched with 35 adenocarcinoma controls, with anastomotic leaks in 4 (11.4%) cases and 2 (5.7%) controls. The morbidity rate was slightly higher in the NET cohort, occurring in 17 (49%) cases compared to 15 (43%) in the adenocarcinoma controls. However, the proportion of severe complications in the adenocarcinoma controls was higher. Neither of the cohorts had mortalities within 30 days of surgery. Overall all‐cause mortality rates and median survival post‐operatively were comparable between the two cohorts.

Conclusion: NETs may be an independent risk factor for anastomotic leak rates; however, further evidence with larger cohorts of patients is required. Due to the low incidence of midgut NETs and midgut adenocarcinomas, a national collaborative is recommended.