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Management of Duodenal Neuroendocrine Tumors: Surgical versus Endoscopic Mucosal Resection

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Management of duodenal neuroendocrine tumors (DNETs) is not standardized, with smaller lesions (< 1–2 cm) generally treated by endoscopic mucosal resection (EMR) and larger DNETs by surgical resection (SR). This study reviewed how patients were selected for treatment and compared outcomes.

Patients and Methods

Patients with DNETs undergoing resection were identified through institutional databases, and clinicopathologic data recorded. χ2 and Wilcoxon tests compared variables. Survival was determined by Kaplan–Meier, and Cox regression tested association with survival.

Results

Among 104 patients, 64 underwent EMR and 40 had SR. Patients selected for SR had larger tumor size, younger age, and higher T, N, and M stage. There was no difference in progression-free (PFS) or overall survival (OS) between SR and EMR. In 1–2 cm DNETs, there was no difference in PFS between SR and EMR [median not reached (NR), P = 0.1]; however, longer OS was seen in SR (median NR versus 112 months, P = 0.03). In 1–2 cm DNETs, SR patients were more likely to be node-positive and younger. After adjustment for age, resection method did not correlate with survival. Comparison of surgically resected DNETs versus jejunoileal NETs revealed longer PFS (median NR versus 73 months, P < 0.001) and OS (median NR versus 119 months, P = 0.004)

Discussion

In 1–2 cm DNETs, there was no difference in survival between EMR and SR after adjustment for age. Recurrences could be salvaged, suggesting that EMR is a reasonable strategy. Compared with jejunoileal NETs, DNETs treated by SR had improved PFS and OS.

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References

  1. Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer. 2003;97(4):934–59.

    Article  Google Scholar 

  2. Yao JC, Hassan M, Phan A, et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008;26(18):3063–72.

    Article  Google Scholar 

  3. Fitzgerald TL, Dennis SO, Kachare SD, Vohra NA, Zervos EE. Increasing incidence of duodenal neuroendocrine tumors: Incidental discovery of indolent disease? Surgery. 2015;158(2):466–71.

    Article  Google Scholar 

  4. Modlin IM, Champaneria MC, Chan AK, Kidd M. A three-decade analysis of 3,911 small intestinal neuroendocrine tumors: the rapid pace of no progress. Am J Gastroenterol. 2007;102(7):1464–73.

    Article  Google Scholar 

  5. Mullen JT, Wang H, Yao JC, et al. Carcinoid tumors of the duodenum. Surgery. 2005;138(6):971–7 (discussion 977-978).

    Article  Google Scholar 

  6. Hoffmann KM, Furukawa M, Jensen RT. Duodenal neuroendocrine tumors: classification, functional syndromes, diagnosis and medical treatment. Best Pract Res Clin Gastroenterol. 2005;19(5):675–97.

    Article  CAS  Google Scholar 

  7. Randle RW, Ahmed S, Newman NA, Clark CJ. Clinical outcomes for neuroendocrine tumors of the duodenum and ampulla of Vater: a population-based study. J Gastrointest Surg. 2014;18(2):354–62.

    Article  Google Scholar 

  8. Massironi S, Campana D, Partelli S, et al. Heterogeneity of duodenal neuroendocrine tumors: an Italian multi-center experience. Ann Surg Oncol. 2018;25(11):3200–6.

    Article  Google Scholar 

  9. Zhang XF, Wu XN, Tsilimigras DI, et al. Duodenal neuroendocrine tumors: Impact of tumor size and total number of lymph nodes examined. J Surg Oncol. 2019;120(8):1302–10.

    Article  Google Scholar 

  10. Gamboa AC, Liu Y, Lee RM, et al. Duodenal neuroendocrine tumors: somewhere between the pancreas and small bowel? J Surg Oncol. 2019;120(8):1293–301.

    Article  Google Scholar 

  11. Delle Fave G, Kwekkeboom DJ, Van Cutsem E, et al. ENETS Consensus guidelines for the management of patients with gastroduodenal neoplasms. Neuroendocrinology. 2012;95(2):74–87.

    Article  CAS  Google Scholar 

  12. Pyun D-K, Moon G, Han J, et al. A carcinoid tumor of the ampulla of Vater treated by endoscopic snare papillectomy. Korean J Intern Med. 2004;19(4):257–60.

    Article  Google Scholar 

  13. Kim SH, Park CH, Ki HS, et al. Endoscopic treatment of duodenal neuroendocrine tumors. Clin Endosc. 2013;46(6):656–61.

    Article  Google Scholar 

  14. Shroff SR, Kushnir VM, Wani SB, et al. Efficacy of endoscopic mucosal resection for management of small duodenal neuroendocrine tumors. Surg Laparosc Endosc Percutan Tech. 2015;25(5):e134–9.

    Article  Google Scholar 

  15. Untch BR, Bonner KP, Roggin KK, et al. Pathologic grade and tumor size are associated with recurrence-free survival in patients with duodenal neuroendocrine tumors. J Gastrointest Surg. 2014;18(3):457–62 (discussion 462-453).

    Article  Google Scholar 

  16. Mahmud N, Tomizawa Y, Stashek K, Katona BW, Ginsberg GG, Metz DC. Endoscopic resection of duodenal carcinoid tumors: a single-center comparison between simple polypectomy and endoscopic mucosal resection. Pancreas. 2019;48(1):60–5.

    Article  Google Scholar 

  17. Gay-Chevallier S, de Mestier L, Perinel J, et al. Management and prognosis of localized duodenal neuroendocrine neoplasms. Neuroendocrinol. 2020;111(8):718–27.

    Article  Google Scholar 

  18. Kumar S, Mahmud N, Roses RE, Katona BW, Ginsberg GG, Metz DC. Resection trends for duodenal carcinoid tumors: a single-center experience. Pancreas. 2020;49(1):e11–3.

    Article  Google Scholar 

  19. Shah MH, Goldner WS, Halfdanarson TR, et al. NCCN Guidelines insights: neuroendocrine and adrenal tumors, Version 2.2018. J Natl Compr Canc Netw. 2018;16(6):693–702.

    Article  CAS  Google Scholar 

  20. Dogeas E, Cameron JL, Wolfgang CL, et al. Duodenal and ampullary carcinoid tumors: size predicts necessity for lymphadenectomy. J Gastrointest Surg. 2017;21(8):1262–9.

    Article  Google Scholar 

  21. Dasari BVM, Al-Shakhshir S, Pawlik TM, et al. Outcomes of surgical and endoscopic resection of duodenal neuroendocrine tumours (NETs): a systematic review of the literature. J Gastrointest Surg. 2018;22(9):1652–8.

    Article  Google Scholar 

  22. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  Google Scholar 

  23. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53(282):457–81.

    Article  Google Scholar 

  24. Shuster JJ. Median follow-up in clinical trials. J Clin Oncol. 1991;9(1):191–2.

    Article  CAS  Google Scholar 

  25. Klemm N, Lu-Cleary D, Chahal D, Trasolini R, Lam E, Donnellan F. Endoscopic management of diminutive duodenal neuroendocrine tumors. J Gastrointest Cancer. 2021;52(2):448–53.

    Article  Google Scholar 

  26. Wang R, Mohapatra S, Jovani M, et al. Risk factors for lymph node metastasis and survival of patients with nonampullary duodenal carcinoid tumors treated with endoscopic therapy versus surgical resection: analysis of the Surveillance, Epidemiology, and End Results program. Gastrointest Endosc. 2021;83(6):1384–482.

    Article  Google Scholar 

  27. Margonis GA, Samaha M, Kim Y, et al. A multi-institutional analysis of duodenal neuroendocrine tumors: tumor biology rather than extent of resection dictates prognosis. J Gastrointest Surg. 2016;20(6):1098–105.

    Article  Google Scholar 

  28. Zyromski NJ, Kendrick ML, Nagorney DM, et al. Duodenal carcinoid tumors: how aggressive should we be? J Gastrointest Surg. 2001;5(6):588–93.

    Article  CAS  Google Scholar 

  29. Iwasaki T, Nara S, Kishi Y, Esaki M, Shimada K, Hiraoka N. Surgical treatment of neuroendocrine tumors in the second portion of the duodenum: a single center experience and systematic review of the literature. Langenbecks Arch Surg. 2017;402(6):925–33.

    Article  Google Scholar 

  30. Lee SW, Sung JK, Cho YS, et al. Comparisons of therapeutic outcomes in patients with nonampullary duodenal neuroendocrine tumors (NADNETs): a multicenter retrospective study. Med. 2019;98(26):e16154–e16154.

    Article  Google Scholar 

  31. Nießen A, Bergmann F, Hinz U, et al. Surgical resection for duodenal neuroendocrine neoplasia: outcome, prognostic factors and risk of metastases. Eur J Surg Oncol. 2020;46(6):1088–96.

    Article  Google Scholar 

  32. Gincul R, Ponchon T, Napoleon B, et al. Endoscopic treatment of sporadic small duodenal and ampullary neuroendocrine tumors. Endoscopy. 2016;48(11):979–86.

    Article  Google Scholar 

  33. Vanoli A, La Rosa S, Klersy C, et al. Four neuroendocrine tumor types and neuroendocrine carcinoma of the duodenum: analysis of 203 cases. Neuroendocrinol. 2017;104(2):112–25.

    Article  CAS  Google Scholar 

Download references

Acknowledgments

This work was supported by NIH grants T32CA148062 (C.G.T.) and T32CA078586 (S.K.S.), and Specialized Programs of Research Excellence Grant P50CA174521 (J.R.H., A.M.B., J.S.D., T.M.O.).

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Authors and Affiliations

  1. Department of Surgery, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, USA

    Catherine G. Tran MD, Scott K. Sherman MD, Mohammed O. Suraju MD, MS, Apoorve Nayyar MBBS, Po Hien Ear PhD & James R. Howe MD

  2. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA

    Henning Gerke MD, Rami G. El Abiad MD, Chandrikha Chandrasekharan MBBS, Thomas M. O’Dorisio MD & Joseph S. Dillon MB, BCh, BAO

  3. Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA

    Andrew M. Bellizzi MD

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  1. Catherine G. Tran MD
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Tran, C.G., Sherman, S.K., Suraju, M.O. et al. Management of Duodenal Neuroendocrine Tumors: Surgical versus Endoscopic Mucosal Resection. Ann Surg Oncol 29, 75–84 (2022). https://doi.org/10.1245/s10434-021-10774-9

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  • DOI: https://doi.org/10.1245/s10434-021-10774-9

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