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Several types of operations can be used to treat GI neuroendocrine tumors. Some of these remove the primary tumor and surrounding lymph nodes with cancer cells (potentially curative surgery), while other operations remove or destroy cancer that has spread to other organs (palliative surgery).

Endoscopic resection

In this procedure, the cancer is removed through an endoscope. This is most often used to treat small neuroendocrine tumors of the stomach and duodenum (the first part of the small intestine), and it also can be used to remove small neuroendocrine tumors of the rectum.

Local excision

This operation removes the primary tumor and some normal tissue around it. The edges of the defect are then sewn together. This usually doesn’t cause any prolonged problems with eating or bowel movements. This operation may be done for small neuroendocrine tumors (no larger than 2 cm, or a little less than an inch).

Neurendocrine tumors are sometimes removed during an operation being done for some other reason. This often happens with neuroendocrine tumors of the appendix. When the appendix is removed (for some other reason), and examined after surgery, sometimes a neuroendocrine tumor is found. Most doctors believe that if the tumor is small — 2 cm or less — removing the appendix (appendectomy) is curative and no other surgery is needed. If the tumor is larger than 2 cm, more surgery may be needed.

Rectal neuroendocrine tumors may be removed  through the anus, without cutting the skin. Other GI neuroendocrine tumors can sometimes be removed through an endoscope but usually it is done through an incision (cut) in the skin.

More extensive surgeries

A larger incision (cut) is needed to remove a larger tumor and nearby tissues. This also lets the surgeon see if the tumor has grown into other tissues in the abdomen (belly). If it has, the surgeon may be able to remove the areas where the cancer has spread.

Partial gastrectomy: In this operation, part of the stomach is removed. If the upper part is removed, sometimes part of the esophagus also is removed. If the lower part of the stomach is removed, sometimes the first part of the small intestine (the duodenum) is also taken. Nearby lymph nodes are also removed. This operation is also known as a subtotal gastrectomy.

Small bowel (intestine) resection: This operation removes a piece of the small intestine (also called the small bowel). When it is used to treat a small bowel neuroendocrine tumor, the tumor and some of the small bowel around it (called a wide margin resection) are removed. Also removed are nearby (regional) lymph nodes and the supporting connective tissue (called the mesentery) that contains lymph nodes and vessels that carry blood to and from the intestine. Tumors in the terminal ileum (the last part of the small bowel) may require removing the right side of the colon (hemicolectomy).

Pancreaticoduodenectomy or Whipple procedure: This operation is most often used to treat pancreatic cancer, but it is also used to treat cancers of the duodenum (the first part of the small intestine). It removes the duodenum, part of the pancreas, nearby lymph nodes, and part of the stomach. The gallbladder and part of the common bile duct are removed, and the remaining bile duct is attached to the small intestine so that bile from the liver can continue to enter the small intestine. This is a complex operation that requires a lot of skill and experience. It carries a relatively high risk of complications that could even be fatal.

Hemicolectomy: This operation removes between one-third and one-half of the colon, as well as the nearby layers of tissue that hold and connect the intestines ( the mesentery), including blood vessels and lymph nodes.

Low anterior resection (LAR): This operation can be used for some tumors in the upper part of the rectum. It removes some of the rectum, and the remaining ends are sewn together (connected).

Abdominoperineal (AP) resection: This surgery is done for large or very invasive cancers in the lower part of the rectum. It removes the anus, rectum, and lower part of the colon. After this operation, the end of the colon is connected to an opening on the skin on the abdomen (called a colostomy). A bag attached over this opening collects stool (feces) as it leaves the body. (For more information, see About Colostomies).

Liver resection

In this operation, pieces of the liver that have areas of cancer are removed. If it isn’t possible to remove all the cancer, surgery may still be done to remove as much of the tumor as possible to help reduce symptoms of carcinoid syndrome. This is sometimes called cytoreductive surgery. Removing liver metastases may help some people with neuroendocrine tumors live longer, but most people who have this surgery will eventually develop new liver metastases.