Evolution of surgery for small bowel neuroendocrine neoplasms

This thesis focuses on different aspects of surgical treatment of patient with small bowel neuroendocrine neoplasms (SB-NEN), including treatment of liver metastases, and application of minimally invasive and fluorescence guided surgery. Besides observational studies to assess the status quo and outcomes of (minimally invasive) surgical treatment, we also performed exploratory and experimental studies to investigate the association of mesenteric fibrosis with IgG4 expression and application of fluorescence guided surgery. The latter two studies can potentially facilitate further implementation of minimally invasive surgery in SB-NEN. Potential effectiveness of induction therapy to reduce mesenteric fibrosis would ease dissection, whilst fluorescence guided surgery is a helpful tool in assessing anastomotic perfusion and with the future potential to guide the resection with tumour-targeting. Hence, the individual chapters should be regarded as steppingstones in application of minimally invasive surgery for SB-NEN.