Surgical management of small bowel neuroendocrine neoplasms in Crohn’s disease: a multicenter retrospective analysis

Background Crohn's disease (CD) is associated with an increased risk of small bowel neuroendocrine neoplasms (SBNENs). However, data on postsurgical outcomes are limited. This multicenter study aimed to analyze the clinicopathological characteristics, surgical management, and outcomes of patients with CD who underwent surgery for SBNENs. Methods A multicenter, retrospective analysis was conducted on patients with a history of CD who underwent surgical resection for an SBNEN between September 1992 and March 2025. Data on patient and tumor characteristics, surgical details, and postoperative outcomes were collected and analyzed. Time-to-event analysis was used to determine the recurrence and survival rates. Results The study included 22 patients (63.4% male) with a median age of 49 years at CD diagnosis. An interval of 108 months was noted between CD diagnosis and SBNEN detection. SBNENs were often an incidental finding during surgery (36.4%). Most tumors were in the ileum (72.7%), were grade 2 (72.7%), and presented with nodal metastases (59.1%). Complete surgical resection (R0) was achieved in 90.9% of cases, primarily through an open approach (68.2%). The postoperative morbidity rate was 50%. No local recurrences occurred over a median follow-up of 120 months, but distant recurrence (liver metastases) was observed in 13.6% of patients, with a cancer-related mortality rate of 9.1%. Conclusion Surgical resection for SBNENs in patients with CD provides excellent long-term oncologic control, although it is associated with considerable perioperative morbidity. The diagnosis is often delayed or incidental, underscoring the need for increased clinical suspicion and potentially enhanced surveillance strategies in this high-risk population.