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Hers F, Klümpen HJ, Dreijerink KMA, Engelsman AF, Nieveen van Dijkum EJM, Kaçmaz E. Endoscopic versus surgical resection of duodenal neuroendocrine neoplasms between 10 and 20 mm: A multi-centered retrospective cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108596. [PMID: 39213696 DOI: 10.1016/j.ejso.2024.108596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 07/31/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Recommendations for resection technique of duodenal neuroendocrine neoplasms (D-NEN) with a size between 10 and 20 mm are lacking. The primary aim was to compare overall survival (OS) and progression-free survival (PFS) after endoscopic resection (ER) with surgical resection (SR). The secondary aim was to assess the incidence and clinical variables correlated with OS. METHODS Data of patients with D-NENs between 2008 and 2018 were extracted from the Netherlands Cancer Registry and the Dutch Nationwide Pathology Databank. RESULTS A total of 259 patients were identified, of which 138 were included: 98 (68 %) underwent ER and 44 patients (32 %) underwent SR. Of these, 38 patients had D-NENs sized between 10 and 20 mm. ER Patients were more frequently male and had a lower T-stage and tumour size than SR patients (all P < 0.05). Positive resection margins were observed more frequently after ER compared to SR (71 % vs 15 %, P < 0.005). No patients with tumours between 10 and 20 mm died after ER or SR (median follow-up 71.8 vs. 52.0 months). PFS rates were not significantly different after ER compared to SR (P = 0.672). Recurrence rates were 13 % for ER and 7 % for SR (P = 0.604). CONCLUSION Between 2008 and 2018, the incidence increased from 0.06 to 0.11 per 100,000 patients per year. OS after ER or SR did not differ for D-NEN between 10 and 20 mm. Recurrence and PFS rates were not significantly different. These results suggest that D-NENs sized between 10 and 20 mm could potentially be treated first with ER. Future studies are needed to confirm this hypothesis.
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Affiliation(s)
- Felix Hers
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Center for Endocrine and Neuroendocrine Tumours (ACcENT), Cancer Center Amsterdam, ENETS Center of Excellence, Amsterdam, The Netherlands; Amsterdam Cancer Center, Amsterdam, The Netherlands
| | - Heinz-Josef Klümpen
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Center for Endocrine and Neuroendocrine Tumours (ACcENT), Cancer Center Amsterdam, ENETS Center of Excellence, Amsterdam, The Netherlands; Amsterdam Cancer Center, Amsterdam, The Netherlands
| | - Koen M A Dreijerink
- Department of Endocrinology and Metabolism, Amsterdam UMC Location VU University, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Center for Endocrine and Neuroendocrine Tumours (ACcENT), Cancer Center Amsterdam, ENETS Center of Excellence, Amsterdam, The Netherlands; Amsterdam Cancer Center, Amsterdam, The Netherlands
| | - Anton F Engelsman
- Amsterdam Center for Endocrine and Neuroendocrine Tumours (ACcENT), Cancer Center Amsterdam, ENETS Center of Excellence, Amsterdam, The Netherlands; Amsterdam Cancer Center, Amsterdam, The Netherlands; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
| | - Els J M Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Center for Endocrine and Neuroendocrine Tumours (ACcENT), Cancer Center Amsterdam, ENETS Center of Excellence, Amsterdam, The Netherlands; Amsterdam Cancer Center, Amsterdam, The Netherlands
| | - Enes Kaçmaz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Center for Endocrine and Neuroendocrine Tumours (ACcENT), Cancer Center Amsterdam, ENETS Center of Excellence, Amsterdam, The Netherlands; Amsterdam Cancer Center, Amsterdam, The Netherlands.
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Han L, Li J, Liang C, Chu Y, Wang Y, Lv L, Liu D, Tan Y. Risk factors for positive resection margins after endoscopic resection for gastrointestinal neuroendocrine tumors. Surg Endosc 2024; 38:2041-2049. [PMID: 38429572 DOI: 10.1007/s00464-024-10706-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/18/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND In recent years, the incidence of gastrointestinal neuroendocrine tumors (GI-NETs) has remarkably increased due to the widespread use of screening gastrointestinal endoscopy. Currently, the most common treatments are surgery and endoscopic resection. Compared to surgery, endoscopic resection possesses a higher risk of resection margin residues for the treatment of GI-NETs. METHODS A total of 315 patients who underwent surgery or endoscopic resection for GI-NETs were included. We analyzed their resection modality (surgery, ESD, EMR), margin status, Preoperative marking and Prognosis. RESULTS Among 315 patients included, 175 cases underwent endoscopic resection and 140 cases underwent surgical treatment. A total of 43 (43/175, 24.57%) and 10 (10/140, 7.14%) patients exhibited positive resection margins after endoscopic resection and surgery, respectively. Multivariate regression analysis suggested that no preoperative marking and endoscopic treatment methods were risk factors for resection margin residues. Among the patients with positive margin residues after endoscopic resection, 5 patients underwent the radical surgical resection and 1 patient underwent additional ESD resection. The remaining 37 patients had no recurrence during a median follow-up of 36 months. CONCLUSIONS Compared with surgery, endoscopic therapy has a higher margin residual rate. During endoscopic resection, preoperative marking may reduce the rate of lateral margin residues, and endoscopic submucosal dissection may be preferred than endoscopic mucosal resection. Periodical follow-up may be an alternative method for patients with positive margin residues after endoscopic resection.
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Affiliation(s)
- Liu Han
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center for Digestive Diseases in Hunan Province, Changsha, 410011, Hunan, China
| | - Jianglei Li
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center for Digestive Diseases in Hunan Province, Changsha, 410011, Hunan, China
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, 410000, Hunan, China
| | - Chengbai Liang
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center for Digestive Diseases in Hunan Province, Changsha, 410011, Hunan, China
| | - Yi Chu
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center for Digestive Diseases in Hunan Province, Changsha, 410011, Hunan, China
| | - Yongjun Wang
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center for Digestive Diseases in Hunan Province, Changsha, 410011, Hunan, China
| | - Liang Lv
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center for Digestive Diseases in Hunan Province, Changsha, 410011, Hunan, China
| | - Deliang Liu
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
- Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan, China.
- Clinical Research Center for Digestive Diseases in Hunan Province, Changsha, 410011, Hunan, China.
| | - Yuyong Tan
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
- Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan, China.
- Clinical Research Center for Digestive Diseases in Hunan Province, Changsha, 410011, Hunan, China.
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Fujiwara S, Koyamada N, Miyazawa K, Saiki Y, Horii A, Miyazaki S. Duodenal neuroendocrine tumor after bilateral breast cancer with type 1 neurofibromatosis: a case report. Surg Case Rep 2024; 10:28. [PMID: 38282102 PMCID: PMC10822824 DOI: 10.1186/s40792-024-01827-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 01/19/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Young women with NF1 are at a high risk of developing breast cancer. Although they are at risk for abdominal tumors, such as gastrointestinal stromal tumors and neuroendocrine tumors, follow-up strategies for other tumors after breast cancer have not yet been established. Here, we present a case of duodenal neuroendocrine tumor found during follow-up after bilateral mastectomy for breast cancer with type 1 neurofibromatosis (NF1), for which pancreaticoduodenectomy (PD) and lymphadenectomy were performed. CASE PRESENTATION A 46-year-old woman with NF1 was referred to our hospital for treatment of a duodenal submucosal tumor. Her previous operative history included bilateral mastectomy for breast cancer: right total mastectomy and left partial mastectomy performed 9 and 5 years ago, respectively. Her daughter was confirmed to have NF1, but her parents were unclear. Although she had no recurrence or symptoms during the follow-up for her breast cancer, she wished to undergo 18-fluorodeoxyglucose-positron emission tomography (FDG-PET) for systemic screening. FDG-PET demonstrated FDG accumulation in the duodenal tumor with a maximum standardized uptake value of 5.78. Endoscopy revealed a 20-mm-diameter tumor in the second duodenal portion, and endoscopic biopsy suggested a NET G1. We performed PD and lymphadenectomy for complete. She was doing well without recurrence and was followed up with PET tomography-computed tomography. CONCLUSIONS Early detection of gastrointestinal tumors is difficult, because most of them are asymptomatic. Gastrointestinal screening is important for patients with NF1, and PD with lymphadenectomy is feasible for managing duodenal neuroendocrine tumors, depending on their size.
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Affiliation(s)
- Sho Fujiwara
- Department of Surgery, Iwate Prefectural Chubu Hospital, 17-10 Murasakino, Kitakami, , Iwate, 024-8507, Japan.
- Department of Molecular Pathology, Tohoku University School of Medicine, Sendai, Miyagi, 980-8575, Japan.
- Department of Surgery, Columbia University Irving Medical Center, 622 West 168th St, New York, NY, 10032, USA.
| | - Nozomi Koyamada
- Department of Surgery, Iwate Prefectural Chubu Hospital, 17-10 Murasakino, Kitakami, , Iwate, 024-8507, Japan
| | - Koji Miyazawa
- Department of Surgery, Iwate Prefectural Chubu Hospital, 17-10 Murasakino, Kitakami, , Iwate, 024-8507, Japan
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-0872, Japan
| | - Yuriko Saiki
- Department of Molecular Pathology, Tohoku University School of Medicine, Sendai, Miyagi, 980-8575, Japan
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8575, Japan
- Office of Medical Education, Tohoku University School of Medicine, Sendai, Miyagi, 980-0872, Japan
| | - Akira Horii
- Department of Molecular Pathology, Tohoku University School of Medicine, Sendai, Miyagi, 980-8575, Japan
| | - Shukichi Miyazaki
- Department of Surgery, Iwate Prefectural Chubu Hospital, 17-10 Murasakino, Kitakami, , Iwate, 024-8507, Japan
- Department of Surgery, South Miyagi Medical Center, Ogawara, Shibata, Miyagi, 989-1253, Japan
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Yi K, Kim GH, Kim SJ, Choi CW, Lee MW, Lee BE, Song GA. Long-term outcomes of endoscopic resection for duodenal neuroendocrine tumors. Sci Rep 2023; 13:17908. [PMID: 37863959 PMCID: PMC10589348 DOI: 10.1038/s41598-023-45243-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/17/2023] [Indexed: 10/22/2023] Open
Abstract
Duodenal neuroendocrine tumors (d-NETs) ≤ 10 mm in size, confined to the submucosal layer, without lymph node or distant metastasis, can be treated safely and effectively by endoscopic management. However, most results are based on limited data and short follow-up outcomes. Herein, we aimed to evaluate the short-term and long-term outcomes of endoscopic resection for d-NETs. We retrospectively analyzed 63 patients with 68 d-NETs who had undergone endoscopic resection at two hospitals between January 2009 and December 2021. En-bloc resection, endoscopically complete resection, and histopathologically complete resection rates were evaluated as short-term outcomes. Furthermore, long-term outcomes were analyzed in 46 patients with 50 d-NETs with a follow-up period of > 1 year. The overall en-bloc, endoscopically complete, and histopathologically complete resection rates were 92.6% (63/68), 100% (68/68), and 69.1% (47/68), respectively. Tumor size (> 5 mm) was the only predictive factor for histopathologically incomplete resection (p = 0.015). The procedure-related bleeding and perforation rates were 0% and 5.9%, respectively. No recurrences were observed in patients with histopathologically complete resection and those with histopathologically incomplete resection at a median follow-up period of 48 months (range 12-132 months). Endoscopic resection for d-NETs ≤ 10 mm in size, limited to the submucosal layer, and without lymph node or distant metastasis provides favorable long-term outcomes when endoscopically complete resection is achieved.
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Affiliation(s)
- Kiyoun Yi
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 49241, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 49241, Korea.
| | - Su Jin Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Cheol Woong Choi
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Moon Won Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 49241, Korea
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 49241, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 49241, Korea
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Chetcuti Zammit S, Sidhu R. Small bowel neuroendocrine tumours - casting the net wide. Curr Opin Gastroenterol 2023; 39:200-210. [PMID: 37144538 DOI: 10.1097/mog.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW Our aim is to provide an overview of small bowel neuroendocrine tumours (NETs), clinical presentation, diagnosis algorithm and management options. We also highlight the latest evidence on management and suggest areas for future research. RECENT FINDINGS Dodecanetetraacetic acid (DOTATATE) scan can detect NETs with an improved sensitivity than when compared with an Octreotide scan. It is complimentary to small bowel endoscopy that provides mucosal views and allows the delineation of small lesions undetectable on imaging. Surgical resection is the best management modality even in metastatic disease. Prognosis can be improved with the administration of somatostatin analogues and Evarolimus as second-line therapies. SUMMARY NETs are heterogenous tumours affecting most commonly the distal small bowel as single or multiple lesions. Their secretary behaviour can lead to symptoms, most commonly diarrhoea and weight loss. Metastases to the liver are associated with carcinoid syndrome.
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Affiliation(s)
| | - Reena Sidhu
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Department of Infection, Immunity and Cardiovascular Diseases, University of Sheffield, Sheffield, UK
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Borbath I, Pape UF, Deprez PH, Bartsch DK, Caplin M, Falconi M, Garcia-Carbonero R, Grozinsky-Glasberg S, Jensen RT, Arnold R, Ruszniewski P, Toumpanakis C, Valle JW, O Toole D. ENETS standardized (synoptic) reporting for endoscopy in neuroendocrine tumors. J Neuroendocrinol 2022; 34:e13105. [PMID: 35233848 DOI: 10.1111/jne.13105] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/27/2022] [Accepted: 02/05/2022] [Indexed: 02/06/2023]
Abstract
Despite efforts from various endoscopy societies, reporting in the field of endoscopy remains extremely heterogeneous. Harmonisation of clinical practice in endoscopy has been highlighted by application of many clinical practice guidelines and standards pertaining to the endoscopic procedures and reporting are underlined. The aim of the proposed "standardised reporting" is to (1) facilitate recognition of gastrointestinal neuroendocrine neoplasms (NEN) on initial endoscopy, (2) to enable interdisciplinary decision making for treatment by a multidisciplinary team, (3) to provide a basis for a standardised endoscopic follow-up which allows detection of recurrence or progression reliably, (4) to make endoscopic reports on NEN comparable between different units, and (5) to allow research collaboration between NEN centres in terms of consistency of their endoscopic data. The ultimate goal is to improve disease management, patient outcome and reduce the diagnostic burden on the side of the patient by ensuring the highest possible diagnostic accuracy and validity of endoscopic exams and possibly interventions.
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Affiliation(s)
- Ivan Borbath
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Ulrich-Frank Pape
- Department of Internal Medicine and Gastroenterology, Asklepios Klinik St. Georg, Asklepios Tumorzentrum Hamburg, Hamburg, Germany
- Department of Hepatology and Gastroenterology, Charité Campus Mitte, Charité University Medicine Berlin, Berlin, Germany
| | - Pierre H Deprez
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Detlef Klaus Bartsch
- Department of Visceral-, Thoracic- and Vascular Surgery at the Philipps-University Marburg, Marburg, Germany
| | - Martyn Caplin
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital and University College London, London, UK
| | - Massimo Falconi
- Department of Surgery, San Raffaele Hospital IRCCS, Università Vita-e-Salute, Milan, Italy
| | | | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, Division of Medicine, Endocrinology & Metabolism Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Robert T Jensen
- Gastrointestinal Cell Biology Section, Digestive Disease Branch, National Institute of Health, Bethesda, Maryland, USA
| | - Rudolf Arnold
- Zentrum für Innere Medizin, Universitätsklinikum Marburg, Marburg, Germany
| | - Philippe Ruszniewski
- Department of Gastroenterology-Pancreatology, Beaujon Hospital and Université de Paris, Clichy, France
| | - C Toumpanakis
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital and University College London, London, UK
| | - Juan W Valle
- Department of Medical Oncology, University of Manchester/The Christie NHS Foundation Trust, Manchester, UK
| | - Dermot O Toole
- National Centre for Neuroendocrine Tumours, St Vincent's University Hospital and St James's Hospital and Trinity College Dublin, Dublin, Ireland
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Chen Q, Chen J, Huang Z, Zhao H, Cai J. Comparable survival benefit of local excision versus radical resection for 10- to 20-mm rectal neuroendocrine tumors. Eur J Surg Oncol 2021; 48:864-872. [PMID: 34753616 DOI: 10.1016/j.ejso.2021.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The optimal surgical management for 10- to 20-mm rectal neuroendocrine tumors (RNET) is still a matter of debate. This study aimed to explore the optimal surgical approach for 10- to 20-mm RNET by comparing the outcomes between local excision and radical resection. METHOD We extracted clinicopathological information of 10- to 20-mm RNET from the Surveillance, Epidemiology, and End Results (SEER) database. The 1:2 propensity score matching (PSM) method was used to balance the imbalanced baseline covariates (P < 0.05) between the local excision group and radical resection group. A Cox proportional hazards model was used to identify the risk factors associated with cancer-specific survival (CSS) and overall survival (OS). RESULT A total of 531 RNET patients 10-20 mm in size were included. Patients receiving radical resection had larger tumor sizes (P < 0.001), higher T stages (P < 0.001), higher N stages (P < 0.001), higher M stages (P = 0.002) and higher grades (P = 0.041). For 10-20 mm RNET patients, radical resection had no survival benefit compared with local excision (CSS: HR = 2.048, 95% CI 0.553-7.576, P = 0.283; OS: HR = 1.090, 95% CI 0.535-2.219, P = 0.813). After 1:2 PSM, there was no significant difference between local excision and radical resection. Radical resection still had no survival benefit over local excision (CSS: HR = 0.449, 95% CI 0.050-4.022, P = 0.474; OS: HR = 1.408, 95% CI 0.488-4.061, P = 0.527). In a multivariate analysis of CSS, age >60 years old (P = 0.005), tumour size 14-20 mm (P = 0.011) and M1 stage (P < 0.001) were identified as independent prognostic factors for worse CSS. In multivariate analysis of OS, age>60 years (P＜0.001), male sex (P = 0.007), black race (P = 0.016), and T2/T3/T4 stage (P = 0.007) were significantly associated with worse OS. N stage was not an independent predictive factor for CSS and OS. CONCLUSION This study revealed that for 10- to 20-mm RNET patients, there was no survival benefit for radical resection compared with local excision, which suggested that local excision may be an adequate treatment for these patients.
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Affiliation(s)
- Qichen Chen
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Jinghua Chen
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Zhen Huang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Hong Zhao
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China.
| | - Jianqiang Cai
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China.
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Rossi RE, Milanetto AC, Andreasi V, Campana D, Coppa J, Nappo G, Rinzivillo M, Invernizzi P, Modica R, David A, Partelli S, Lamberti G, Mazzaferro V, Zerbi A, Panzuto F, Pasquali C, Falconi M, Massironi S. Risk of preoperative understaging of duodenal neuroendocrine neoplasms: a plea for caution in the treatment strategy. J Endocrinol Invest 2021; 44:2227-2234. [PMID: 33651317 DOI: 10.1007/s40618-021-01528-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/04/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Pretreatment staging is the milestone for planning either surgical or endoscopic treatment in duodenal neuroendocrine neoplasms (dNENs). Herein, a series of surgically treated dNEN patients was evaluated to assess the concordance between the pre- and postsurgical staging. METHODS Retrospective analysis of patients with a histologically confirmed diagnosis of dNENs, who underwent surgical resection observed at eight Italian tertiary referral centers. The presurgical TNM stage, based on the radiological and functional imaging, was compared with the pathological TNM stage, after surgery. RESULTS From 2000 to 2019, 109 patients were included. Sixty-six patients had G1, 26 a G2, 7 a G3 dNEN (Ki-67 not available in 10 patients). In 46/109 patients (42%) there was disagreement between the pre- and postsurgical staging, being it understaged in 42 patients (38%), overstaged in 4 (3%). As regards understaging, in 25 patients (22.9%), metastatic loco-regional nodes (N) resulted undetected at both radiological and functional imaging. Understaging due to the presence of distal micrometastases (M) was observed in 2 cases (1.8%). Underestimation of tumor extent (T) was observed in 12 patients (11%); in three cases the tumor was understaged both in T and N extent. CONCLUSIONS Conventional imaging has a poor detection rate for loco-regional nodes and micrometastases in the presurgical setting of the dNENs. These results represent important advice when local conservative approaches, such as endoscopy or local surgical excision are considered and it represents a strong recommendation to include endoscopic ultrasound in the preoperative tools for a more accurate local staging.
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Affiliation(s)
- R E Rossi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
- HBP Surgery, Hepatology and Liver Transplantation Unit, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori (INT, National Cancer Institute), Milan, Italy.
| | - A C Milanetto
- Pancreatic and Endocrine Digestive Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padua, Italy
| | - V Andreasi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy
| | - D Campana
- Department of Experimental, Diagnostic and Specialty Medicine, ENETS Center of Excellence, Bologna University, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - J Coppa
- HBP Surgery, Hepatology and Liver Transplantation Unit, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori (INT, National Cancer Institute), Milan, Italy
| | - G Nappo
- Pancreatic Surgery, Humanitas Clinical, and Research Center-IRCCS, ENETS Center of Excellence, Humanitas University, Milan, Rozzano, Italy
| | - M Rinzivillo
- Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - P Invernizzi
- Division of Gastroenterology, San Gerardo Hospital, Bicocca School of Medicine, University of Milano, Monza, Italy
| | - R Modica
- Division of Endocrinology, Department of Clinical Medicine and Surgery, ENETS Center of Excellence, University "Federico II" of Naples, Naples, Italy
| | - A David
- Pancreatic and Endocrine Digestive Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padua, Italy
| | - S Partelli
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy
| | - G Lamberti
- Department of Experimental, Diagnostic and Specialty Medicine, ENETS Center of Excellence, Bologna University, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - V Mazzaferro
- HBP Surgery, Hepatology and Liver Transplantation Unit, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori (INT, National Cancer Institute), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - A Zerbi
- Pancreatic Surgery, Humanitas Clinical, and Research Center-IRCCS, ENETS Center of Excellence, Humanitas University, Milan, Rozzano, Italy
| | - F Panzuto
- Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - C Pasquali
- Pancreatic and Endocrine Digestive Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padua, Italy
| | - M Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy
| | - S Massironi
- Division of Gastroenterology, San Gerardo Hospital, Bicocca School of Medicine, University of Milano, Monza, Italy
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9
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Laird AM, Libutti SK. Management of Other Gastric and Duodenal Neuroendocrine Tumors. Surg Oncol Clin N Am 2021; 29:253-266. [PMID: 32151359 DOI: 10.1016/j.soc.2019.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Gastric and duodenal neuroendocrine tumors (NETs) are increasing in incidence as a result of increased detection and awareness of neuroendocrine tumors as distinct tumor types. The three types of gastric NETs and duodenal NETs have different etiologies and tumor-specific factors, such as grade, location, and hormone-production, and the clinical settings influence management. Options for treatment include removal by local endoscopic resection and surgical resection. Medical therapy is used to treat the inciting condition or as systemic therapy in advanced disease. Although the overall prognosis for most is good, higher grade tumors behave aggressively and have reduced survival.
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Affiliation(s)
- Amanda M Laird
- Section of Endocrine Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, New Brunswick, NJ 08903, USA.
| | - Steven K Libutti
- Section of Endocrine Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, New Brunswick, NJ 08903, USA
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10
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Yoon JY, Kumta NA, Kim MK. The Role of Endoscopy in Small Bowel Neuroendocrine Tumors. Clin Endosc 2021; 54:818-824. [PMID: 33794563 PMCID: PMC8652151 DOI: 10.5946/ce.2020.296] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/30/2020] [Indexed: 02/06/2023] Open
Abstract
Small bowel neuroendocrine tumors (NETs) represent approximately one-third of NETs of the gastrointestinal tract, and their incidence is increasing. When determining if endoscopic resection is appropriate, endoscopic ultrasound is used to assess the lesion size and depth of invasion for duodenal NETs. A number of techniques, including endoscopic mucosal resection (EMR), band-assisted EMR (band-EMR), endoscopic submucosal dissection (ESD), and over-the-scope clip-assisted endoscopic full-thickness resection (EFTR), have been studied; however, the best technique for endoscopic resection remains unclear. The vast majority of currently available data are retrospective, and prospective studies with longer follow-up times are required. For jejunal and ileal NETs, endoscopic techniques such as video capsule endoscopy (VCE) and balloon enteroscopy (BE) assist in diagnosis. This includes localization of the primary NET in metastatic disease where initial workup has been negative, and the identification of multifocal disease, which may change management and prognostication.
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Affiliation(s)
- Ji Yoon Yoon
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nikhil A Kumta
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle Kang Kim
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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11
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Cho HJ, Jang JY, Jeong SY, Kang IC, Lee SH, Choi SH. Robotic limited local resection of duodenal juxta-ampullary neoplasms. Int J Med Robot 2020; 17:e2192. [PMID: 33125798 DOI: 10.1002/rcs.2192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/28/2020] [Accepted: 10/26/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The unique and complex anatomical location of duodenal juxta-ampullary neoplasms complicates selection of the appropriate surgical strategy. For benign or borderline tumours, surgical local resection can be an appropriate treatment option, and robotic surgical systems can help perform minimally invasive local resection of these lesions. METHODS Between December 2014 and December 2019, 10 patients who underwent robotic local resections for duodenal juxta-ampullary tumours were reviewed. RESULTS All patients successfully underwent robotic local resection of the duodenum, preserving the ampulla of Vater without conversion. The mean tumour size was 2.2 cm. Final pathology consisted of gastrointestinal stromal tumour, neuroendocrine tumour, low grade and high grade dysplasia, ectopic pancreas, and well-differentiated adenocarcinoma (T1a). There were no postoperative complications or recurrences. CONCLUSION With accurate preoperative diagnosis and careful selection of patients, local resection of the duodenum for juxta-ampullary benign or borderline tumours using robotic surgical system is an attractive treatment option.
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Affiliation(s)
- Hye Jung Cho
- Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Gyeonggi-do, Republic of Korea
| | - Jae Young Jang
- Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Gyeonggi-do, Republic of Korea
| | - Sung Yub Jeong
- Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Gyeonggi-do, Republic of Korea
| | - In Cheon Kang
- Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Gyeonggi-do, Republic of Korea
| | - Sung Hwan Lee
- Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Gyeonggi-do, Republic of Korea
| | - Sung Hoon Choi
- Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Gyeonggi-do, Republic of Korea
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12
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Nishio M, Hirasawa K, Ozeki Y, Sawada A, Ikeda R, Fukuchi T, Kobayashi R, Makazu M, Sato C, Maeda S. Short- and long-term outcomes of endoscopic submucosal dissection for non-ampullary duodenal neuroendocrine tumors. Ann Gastroenterol 2020; 33:265-271. [PMID: 32382229 PMCID: PMC7196614 DOI: 10.20524/aog.2020.0477] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/11/2020] [Indexed: 02/07/2023] Open
Abstract
Background Endoscopic resection is recommended for non-ampullary duodenal neuroendocrine tumors (NAD-NETs) ≤10 mm in diameter and confined to the submucosal layer, without lymph node or distant metastasis. However, the efficacy and safety of endoscopic submucosal dissection (ESD) for NAD-NET remains unclear. The aim of this study was to assess the short-term efficacy and safety and the long-term outcomes of ESD for NAD-NET. Methods Eight patients with 8 NAD-NETs who underwent ESD between 2015 and 2018 were included. The indications for ESD were: i) tumor ≤10 mm in diameter; ii) NET G1; iii) confined to the submucosal layer; and iv) without lymph node or distant metastasis. We retrospectively assessed the short- and long-term outcomes and safety. Results The median patient age was 69 (48-76) years. All tumors were located in the duodenal bulb and showed 0-Is morphology. The median size was 6.4 (3-9.3) mm. The rates of en bloc resection, histologically free horizontal and vertical margins, and curative resection were 100%, 88%, and 88%, respectively. Intraoperative and postoperative perforation each occurred in 13% of patients, all of whom were treated conservatively and avoided emergent surgery. Delayed bleeding was not observed. No local, lymph node or distant recurrence was observed during a median follow-up period of 34 (18.5-62.5) months. Conclusions The rates of en bloc and curative resection, and histologically free margins were sufficiently high. Although intraoperative and postoperative perforations occurred, emergency surgery was not needed. The results show that ESD is an efficacious and safe treatment for NAD-NET.
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Affiliation(s)
- Masafumi Nishio
- Division of Endoscopy, Yokohama City University Medical Center (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Yuichiro Ozeki
- Division of Endoscopy, Yokohama City University Medical Center (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Atsushi Sawada
- Division of Endoscopy, Yokohama City University Medical Center (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Ryosuke Ikeda
- Division of Endoscopy, Yokohama City University Medical Center (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Takehide Fukuchi
- Division of Endoscopy, Yokohama City University Medical Center (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Ryosuke Kobayashi
- Division of Endoscopy, Yokohama City University Medical Center (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Makomo Makazu
- Division of Endoscopy, Yokohama City University Medical Center (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato)
| | - Shin Maeda
- Department of Gastoenterology, Yokohama City University Guraduate School of Medicine (Shin Maeda), Japan
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13
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Clinicopathological characteristics and frequency of multiple rectal neuroendocrine tumors: a single-center retrospective study. Int J Colorectal Dis 2019; 34:1887-1894. [PMID: 31630212 DOI: 10.1007/s00384-019-03405-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rectal multiple neuroendocrine tumors (M-NETs) are rare, with only few epidemiologic reports on the topic. Therefore, their clinicopathological features are not completely known, and the appropriate treatment strategy has not been established. PURPOSE This study aimed to compare the clinicopathological malignant potential (lymphatic or venous invasion-positive and lymph node metastasis rates) of M-NETs with that of solitary NETs (S-NETs). METHODS We retrospectively investigated 369 patients with NETs of the rectum. Patients who underwent colonoscopy at the Cancer Institute Hospital between January 1979 and 2016 and diagnosed with S-NETs were included, and S-NETs were found in 348 patients. Patients with M-NETs were classified into two groups as follows: patients with < 8 tumors (several (S) group, n = 21) and those with ≥ 8 tumors (numerous (N) group, n = 3). RESULTS The overall frequency of M-NETs was 5.7% and that of the N group was 0.8%. The mean tumor diameter in the N group was 6.0 mm (range, 4-8 mm). The lymphatic invasion rates of the S-NETs, and S and N groups of the M-NETs were 8.9%, 5.6%, and 66.7%, respectively. Moreover, the lymph node metastasis rates were 9.2%, 11.1%, and 33.3, respectively. CONCLUSIONS While M-NETs in the S and N groups had different characteristics, they were rarer in the N group. The N group may have higher rates of lymphatic invasion and lymph node metastasis regardless of tumor size.
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14
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Alekberzade AV, Krylov NN, Garmanova TN, Shahbazov R, Azari F, Zuykova KS, Litovchenko ED. [Duodenal neuroendocrine tumors]. Khirurgiia (Mosk) 2019:87-95. [PMID: 31355821 DOI: 10.17116/hirurgia201907187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Significant augmentation of the incidence of duodenal neuroendocrine tumors duodenum has been observed in recent decades. There are 5 histological types of these tumors: gastrinoma (50-60%), somatostatin-producing tumor (15%), inactive serotonin-containing tumors (20%), poorly differentiated neuroendocrine carcinoma (<3%) and gangliocytic paraganglioma (<2%). The majority of tumors are localized within the bulb and postbulbar part of duodenum, 20% are found in periampular area. Treatment strategy depends on dimensions, localization, histological class, stage and type of tumor. It is believed that endoscopic resection is permissible for small inactive tumors (G1) located above major duodenal papilla. The majority of other neoplasms requires surgical resection. Personal experience of various surgeons is limited by small group of patients. Therefore, it is necessary to summarize results for selection of optimal treatment.
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Affiliation(s)
- A V Alekberzade
- Sechenov First Moscow State Medical University of Ministry of Health of Russia, Moscow, Russia
| | - N N Krylov
- Sechenov First Moscow State Medical University of Ministry of Health of Russia, Moscow, Russia
| | - T N Garmanova
- Sechenov First Moscow State Medical University of Ministry of Health of Russia, Moscow, Russia
| | - R Shahbazov
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - F Azari
- Department of Surgery, University of Pennsylvania, Philadelphia PA, USA
| | - K S Zuykova
- Sechenov First Moscow State Medical University of Ministry of Health of Russia, Moscow, Russia
| | - E D Litovchenko
- Sechenov First Moscow State Medical University of Ministry of Health of Russia, Moscow, Russia
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15
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Lee SW, Sung JK, Cho YS, Bang KB, Kang SH, Kim KB, Kim SH, Moon HS, Song KH, Kim SM, Chung IK, Lee DS, Jeong HY, Youn SJ. Comparisons of therapeutic outcomes in patients with nonampullary duodenal neuroendocrine tumors (NADNETs): A multicenter retrospective study. Medicine (Baltimore) 2019; 98:e16154. [PMID: 31261543 PMCID: PMC6617016 DOI: 10.1097/md.0000000000016154] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Duodenal neuroendocrine tumors (DNETs) are rare tumors that are occasionally found during upper endoscopies. The incidence of DNETs is increasing, although the data regarding treatment outcomes are insufficient. The aim of this study was to evaluate the treatment outcomes in patients with nonampullary DNETs who underwent endoscopic resection or surgery. We evaluated the medical records of patients who were diagnosed with nonampullary DNETs from 2004 to 2017 in 7 university hospitals. We retrospectively analyzed clinical characteristics and compared therapeutic outcomes based on the endoscopic lesion size and treatment method. We ultimately enrolled 60 patients with nonampullary DNETs who underwent endoscopic and surgical treatments. In the endoscopic treatment group, the en bloc resection, endoscopic complete resection (CR) and pathologic CR rates were 88%, 92%, and 50%, respectively. The endoscopic treatment group was divided into 3 subgroups based on the lesion size (1-5 mm, 6-10 mm, and ≥11 mm). The pathologic CR rate was significantly lower in the subgroup with a lesion size ≥11 mm (0%, P = .003) than those in the other 2 subgroups. Lymphovascular invasion occurred significantly more frequently (33.3%, P = .043) among those with a lesion size ≥11 mm. The pathologic CR rate in the surgical treatment group was higher (90.9%) than that in the endoscopic treatment group (50%, P = .017). Surgical treatment appears to be a more appropriate choice because of the risks of incomplete resection and lymphovascular invasion after endoscopic treatment for lesions larger than 11 mm.
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Affiliation(s)
- Seung Woo Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea
| | - Jae Kyu Sung
- Department of Internal Medicine, Chungnam National University, College of Medicine
| | - Young Sin Cho
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan
| | - Ki Bae Bang
- Department of Internal Medicine, Dankook University College of Medicine
| | - Sun Hyung Kang
- Department of Internal Medicine, Chungnam National University, College of Medicine
| | - Ki Bae Kim
- Department of Internal Medicine, Chungbuk National University School of Medicine
| | - Sae Hee Kim
- Department of Internal Medicine, College of Medicine, Eulji University
| | - Hee Seok Moon
- Department of Internal Medicine, Chungnam National University, College of Medicine
| | - Kyung Ho Song
- Department of Internal Medicine, College of Medicine, Konyang University, Republic of Korea
| | - Sun Moon Kim
- Department of Internal Medicine, College of Medicine, Konyang University, Republic of Korea
| | - Il-Kwun Chung
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan
| | - Dong Soo Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea
| | - Hyun Yong Jeong
- Department of Internal Medicine, Chungnam National University, College of Medicine
| | - Sei Jin Youn
- Department of Internal Medicine, Chungbuk National University School of Medicine
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16
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Endoscopic submucosal resection using a ligation device without injection for duodenal neuroendocrine tumors. Surg Endosc 2019; 33:2008-2014. [PMID: 30604268 DOI: 10.1007/s00464-018-06642-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/19/2018] [Indexed: 01/20/2023]
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17
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Endoscopic Resection of Duodenal Carcinoid Tumors: A Single-Center Comparison Between Simple Polypectomy and Endoscopic Mucosal Resection. Pancreas 2019; 48:60-65. [PMID: 30451799 PMCID: PMC6289751 DOI: 10.1097/mpa.0000000000001197] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Endoscopic resection is preferred for duodenal carcinoids less than 20 mm; however, the efficacy of simple polypectomy has not been compared with advanced endoscopic resection techniques. METHODS We performed a retrospective review of 33 patients who underwent endoscopic duodenal carcinoid resection (10 simple, 23 endoscopic mucosal resection) at the Hospital of the University of Pennsylvania between January 1, 2006, and June 15, 2017. The primary outcomes were resection margin positivity and local tumor recurrence. RESULTS There were no significant differences in demographics or tumor functionality. Lesions managed with simple polypectomy had smaller median gross specimen size (6.0 mm vs 8.0 mm, P = 0.043). There was no significant difference in pathology resection margins between simple polypectomy and endoscopic mucosal resection (86% vs 68% positive, P = 0.64). Local recurrence on surveillance endoscopy was also similar (14.3% vs 17.7%, respectively; P = 1.000), with median time to recurrence 2.3 months (interquartile range, 1.2-5.4 months). The median follow-up time in patients without local recurrence was 21.4 months (interquartile range, 7.1-39.6 months). CONCLUSIONS Simple polypectomy may be adequate treatment of small duodenal carcinoids, although further studies are needed for validation and to define the upper limits of tumor size that can be managed with this technique.
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18
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19
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Dhaduk VR, Johri V, Majesty SRH, Mushtaque N, Jain N, Reddy PK. Laparoscopic resection of duodenal carcinoid: A feasible method: Single institute case series. J Minim Access Surg 2018; 16:24-29. [PMID: 30106022 PMCID: PMC6945343 DOI: 10.4103/jmas.jmas_131_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Duodenal carcinoids (neuroendocrine tumour) are rare tumour, but recently, increase in incidence has been noted. Various techniques for excision of tumour have been described in literature, but very few case reports and case series have mentioned about laparoscopic management of carcinoid tumour. We describe a case series of seven cases of duodenal non-periampullary carcinoids which was managed by laparoscopic method. Aims The aim of the study was to check feasibility of laparoscopic management of duodenal carcinoid and technique of surgery. Settings and Design This study design was a case series and prospective data were retrospectively collected. Materials and Methods A total of 7 patients were operated for carcinoid tumour of duodenum mainly involving first part by laparoscopic method from February 2016 to January 2017. All patients were followed up for minimum 1-year period and various pre-operative, intra-operative findings and post-operative outcome were noted. Results Out of seven patients, 6 patient were managed by laparoscopic duodenotomy and transduodenal excision whereas one patient required duodenectomy of first part. Mean operative time was 99 min, mean intraoperative blood loss was 55.7, mean hospital stay was 99.7 and no recurrence in a 1-year follow-up. Conclusions Laparoscopic excision of carcinoid tumour is safe, technically reproducible and feasible method.
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Affiliation(s)
- Vimalkumar R Dhaduk
- Department of Surgical Gastroenterology and Minimal Access and Bariatric Surgery, Apollo Hospital Chennai, India
| | - Vishwas Johri
- Department of Surgical Gastroenterology and Minimal Access and Bariatric Surgery, Apollo Hospital Chennai, India
| | - S R Harshavardan Majesty
- Department of Surgical Gastroenterology and Minimal Access and Bariatric Surgery, Apollo Hospital Chennai, India
| | - Nadeem Mushtaque
- Department of Surgical Gastroenterology and Minimal Access and Bariatric Surgery, Apollo Hospital Chennai, India
| | - Nikunj Jain
- Department of Surgical Gastroenterology and Minimal Access and Bariatric Surgery, Apollo Hospital Chennai, India
| | - Prasanna Kumar Reddy
- Department of Surgical Gastroenterology and Minimal Access and Bariatric Surgery, Apollo Hospital Chennai, India
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20
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Rossi RE, Rausa E, Cavalcoli F, Conte D, Massironi S. Duodenal neuroendocrine neoplasms: a still poorly recognized clinical entity. Scand J Gastroenterol 2018; 53:835-842. [PMID: 29726295 DOI: 10.1080/00365521.2018.1468479] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/16/2018] [Accepted: 04/16/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Duodenal neuroendocrine neoplasms (dNENs) are rare tumors, which usually show good prognosis. The optimal management of these tumors is still far from being clearly understood because of their rarity and the poor level of knowledge about their natural history. Herein, we have reviewed the literature on dNENs to collect and analyze the current data on epidemiology, diagnosis and management of these rare tumors. METHODS Bibliographical searches were performed in PubMed, using the following keywords: duodenal neuroendocrine neoplasm; duodenum; gastrinoma; diagnosis; therapy; guidelines. We searched for all relevant articles published over the last 15 years. Non-English language papers were excluded. RESULTS We reviewed the pertinent articles about dNENs. Upper gastrointestinal endoscopy with biopsy is the cornerstone of the dNENs diagnostic process. Endoscopic ultrasound with fine-needle aspiration/biopsy should be performed in order to locally stage the disease and in all cases of non-diagnostic endoscopy. Endoscopic or complete surgical removal of the primary lesion is the recommended treatment and is generally achievable for the majority of the patients. A less aggressive approach may be suggested for well-differentiated low-stage tumors. After NEN removal, patients should be closely followed-up especially during the first 3 years by endoscopic examination, imaging tests and CgA measurements. CONCLUSIONS The multi-disciplinary approach and the preservation of the quality of life of the patients play a key role in the therapeutic process for dNENs. Further studies are needed to better define standardized guidelines specific to dNENs, including optimal management approaches and follow-up intervals.
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Affiliation(s)
- Roberta Elisa Rossi
- a Department of Gastroenterology and Endoscopy , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy
- b Department of Pathophysiology and Organ Transplant , Università degli Studi di Milano , Milan , Italy
| | - Emanuele Rausa
- c General and Emergency Surgery Department , ASST Trauma Center "Papa Giovanni XXIII" Hospital , Bergamo , Italy
| | - Federica Cavalcoli
- a Department of Gastroenterology and Endoscopy , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy
- b Department of Pathophysiology and Organ Transplant , Università degli Studi di Milano , Milan , Italy
| | - Dario Conte
- a Department of Gastroenterology and Endoscopy , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy
- b Department of Pathophysiology and Organ Transplant , Università degli Studi di Milano , Milan , Italy
| | - Sara Massironi
- a Department of Gastroenterology and Endoscopy , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy
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Chin JL, O'Toole D. Diagnosis and Management of Upper Gastrointestinal Neuroendocrine Tumors. Clin Endosc 2017; 50:520-529. [PMID: 29207862 PMCID: PMC5719910 DOI: 10.5946/ce.2017.181] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/19/2017] [Indexed: 12/14/2022] Open
Abstract
Upper gastrointestinal neuroendocrine tumors (NETs) are rare tumors which are increasingly recognised by practising endoscopists. After confirmation by endoscopic biopsies of these focal lesions, many questions may arise. As NETs are less frequently encountered compared to other malignancies or gastrointestinal pathology, many endoscopists may not fully understand the natural history, diagnosis and management of these tumors. In this review, we aim to update the practising endoscopist on the key clinical features and management of patients with upper gastrointestinal NET.
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Affiliation(s)
- Jun Liong Chin
- Department of Gastroenterology, St. Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Dermot O'Toole
- Department of Gastroenterology, St. Vincent's University Hospital, University College Dublin, Dublin, Ireland.,Department of Clinical Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
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22
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Wang HM, Liang CM, Wu CK, Chiu YC, Chou YP, Wu KL, Huang CC, Chuah SK, Tai WC, Lu LS. Metachronous duodenal neuroendocrine neoplasms after endoscopic mucosal resection. ADVANCES IN DIGESTIVE MEDICINE 2017. [DOI: 10.1002/aid2.12071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Hsin-Ming Wang
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
| | - Chih-Ming Liang
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
| | - Cheng-Kun Wu
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
| | - Yi-Chun Chiu
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
- Chang Gung University College of Medicine; Taoyuan Taiwan
| | - Yeh-Pin Chou
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
- Chang Gung University College of Medicine; Taoyuan Taiwan
| | - Keng-Liang Wu
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
- Chang Gung University College of Medicine; Taoyuan Taiwan
| | - Chao-Cheng Huang
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
- Chang Gung University College of Medicine; Taoyuan Taiwan
- Department of Pathology; Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
- Biobank and Tissue Bank; Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
| | - Seng-Kee Chuah
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
- Chang Gung University College of Medicine; Taoyuan Taiwan
| | - Wei-Chen Tai
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
- Chang Gung University College of Medicine; Taoyuan Taiwan
| | - Lung-Sheng Lu
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
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Osera S, Oono Y, Ikematsu H, Yano T, Kaneko K. Endoscopic submucosal resection with a ligation device for the treatment of duodenal neuroendocrine tumors. Surg Endosc 2016; 30:3928-3932. [PMID: 26675937 DOI: 10.1007/s00464-015-4703-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/19/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Endoscopic submucosal resection with a ligation device (ESMR-L) is effective for rectal neuroendocrine tumors (NETs); however, its effectiveness for duodenal NETs is unclear. This study evaluated the efficacy and safety of ESMR-L for duodenal NETs. METHODS A total of 32 consecutive patients with duodenal NETs were treated in our hospital between December 2010 and August 2015. Among these 32 patients, we retrospectively analyzed the data of all patients who underwent ESMR-L for the treatment of duodenal NETs. ESMR-L was considered for patients in whom (1) the lesion size was ≤10 mm in diameter, (2) the lesion was located within the submucosal layer, and (3) no lymph node metastasis or distant metastasis was detected. RESULTS Five patients underwent ESMR-L for the treatment of duodenal NETs. The en bloc complete resection rate was 100 %. The median procedure time for ESMR-L was 15 min (range 10-30 min). In all patients, perforation during and after the operation, and intraoperative bleeding were not observed; however, one patient experienced postoperative bleeding. During follow-up, no local recurrence or distant metastasis was noted in any of the patients. CONCLUSION ESMR-L is feasible, effective, and safe for duodenal NETs measuring ≤10 mm in diameter that are confined to the submucosal layer without metastasis.
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Affiliation(s)
- Shozo Osera
- Department of Gastroenterology and Gastrointestinal Oncology, Endoscopy Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Yasuhiro Oono
- Department of Gastroenterology and Gastrointestinal Oncology, Endoscopy Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan.
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Gastrointestinal Oncology, Endoscopy Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Gastrointestinal Oncology, Endoscopy Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Kazuhiro Kaneko
- Department of Gastroenterology and Gastrointestinal Oncology, Endoscopy Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
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Efficacy of Endoscopic Mucosal Resection for Management of Small Duodenal Neuroendocrine Tumors. Surg Laparosc Endosc Percutan Tech 2016; 25:e134-9. [PMID: 26271024 DOI: 10.1097/sle.0000000000000192] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Endoscopic mucosal resection (EMR) for small (<20 mm) duodenal neuroendocrine tumors (NETs) remains controversial because of their rarity. MATERIALS AND METHODS This is a retrospective cohort study of patients with surgically or endoscopically resected duodenal NETs from 2001 to 2011. The primary outcome is the rate of disease-free status following resection. A secondary outcome is the sensitivity of endoscopic ultrasound (EUS) in determining NET appropriateness for EMR. RESULTS Thirty patients underwent resection of duodenal NETs (EMR 20, surgery 10). Tumor was present at the margins in 40% of EMR-resected NETs and 10% of surgically resected NETs. Five patients who underwent EMR had residual disease treated with repeat EMR (3) and surgery (2). EUS demonstrated 96% sensitivity in determining lesions limited to the submucosa. CONCLUSIONS EMR for small duodenal NETs can be a safe and effective alternative to surgery in carefully selected patients. EUS is a useful adjunct in determining depth of invasion for duodenal NETs.
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A Multi-institutional Analysis of Duodenal Neuroendocrine Tumors: Tumor Biology Rather than Extent of Resection Dictates Prognosis. J Gastrointest Surg 2016; 20:1098-105. [PMID: 27008594 DOI: 10.1007/s11605-016-3135-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/15/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Duodenal neuroendocrine tumors (NETs) are rare neoplasms with poorly defined management. We sought to evaluate the outcomes of patients undergoing resection of duodenal NETs. METHODS Using a multi-institutional database, 146 patients who underwent resection for duodenal NETs between 1993 and 2015 were identified. Data on clinicopathologic characteristics and outcomes were collected and analyzed. RESULTS Local surgical resection (LR) was performed in 57 (39.0 %) patients, while 50 (34.3 %) patients underwent pancreaticoduodenectomy (PD) and 39 (26.7 %) patients an endoscopic resection (ER). Factors associated with worse RFS included advanced tumor grade and metastasis at diagnosis (both P < 0.05) but not procedure type (P > 0.05). Among patients who had at least one lymph node examined (n = 85), 50 (58.8 %) had a metastatic lymph node; lymph node metastasis (P = 0.04) and advanced tumor grade (P = 0.04) were more common among patients with tumors >1.5 cm. Median length-of-stay was longer for PD versus LR (P < 0.001). PD patients were at increased risk for severe postoperative complications (P = 0.01). CONCLUSION Recurrence of duodenal NETs was dependent on tumor biology rather than procedure type. PD was associated with a longer hospital stay and higher risk of perioperative complications. For patients with tumors ≤1.5 cm, LR or ER may be appropriate with PD reserved for larger lesions and those not amenable to a more local approach.
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26
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Jung HJ, Hong SJ, Han JP, Kim HS, Jeong GA, Cho GS, Kim HK, Ko BM, Lee MS. Long-term outcome of endoscopic and surgical resection for foregut neuroendocrine tumors. J Dig Dis 2015; 16:595-600. [PMID: 26315879 DOI: 10.1111/1751-2980.12279] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/02/2015] [Accepted: 08/03/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Endoscopic resection (ER) of foregut neuroendocrine tumors (NETs) is increasingly performed instead of surgery. This study aimed to compare the long-term therapeutic outcomes of ER and surgical resection (SR) for foregut NETs. METHODS From 2002 to 2012, a total of 49 patients with histologically confirmed foregut NETs were treated by ER (n = 33) and SR (n = 16). The clinicopathological characteristics and therapeutic outcomes were evaluated. RESULTS Of the 33 patients who underwent ER [endoscopic mucosal resection (n = 26), endoscopic mucosal dissection (n = 7)], 32 were diagnosed as NET-G1 and NET-G2, and the other as neuroendocrine carcinoma (NEC). Of the 16 patients who underwent SR, 10 were diagnosed as NET-G1, 2 as NET-G2 and 4 as NEC. The median tumor size was significantly smaller in the ER group compared with the SR group (7 mm vs 19 mm, P = 0.001). In almost all patients treated with ER (32/33), NET invasion was limited to the mucosa and submucosa. Non-curative resections were observed in 24.2% of the patients in the ER group (8/33) and 25.0% in the SR group (4/16). No recurrence occurred in NET cases with positive resection margins by ER. However, all cases of non-curative resection with lymphatic invasion (one in the ER group and four in the SR group) developed liver metastasis during the follow-up despite complete resection, and all these five patients has histologically confirmed NECs. CONCLUSION NET patients treated by ER may have a good prognosis if the tumor size is small and histologically low grade without lymphatic invasion.
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Affiliation(s)
- Hee Jae Jung
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine
| | - Su Jin Hong
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine
| | - Jae Pil Han
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine
| | - Hyun Su Kim
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine
| | - Gui-Ae Jeong
- Department of Surgery, Soonchunhyang University College of Medicine
| | - Gyu-Seok Cho
- Department of Surgery, Soonchunhyang University College of Medicine
| | - Hee Kyoung Kim
- Department of Pathology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Bong Min Ko
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine
| | - Moon Sung Lee
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine
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27
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Min BH, Kim ER, Lee JH, Kim KM, Min YW, Rhee PL, Kim JJ, Rhee JC. Management strategy for small duodenal carcinoid tumors: does conservative management with close follow-up represent an alternative to endoscopic treatment? Digestion 2014; 87:247-53. [PMID: 23751414 DOI: 10.1159/000349958] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 02/09/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Limited data exist regarding the natural history of duodenal carcinoid tumors and the efficacy of endoscopic treatment. METHODS A total of 27 patients with duodenal carcinoid tumors were enrolled. All tumors were located outside the periampullary region and were ≤10 mm in size. 11 patients underwent endoscopic mucosal resection (EMR) and argon plasma coagulation (APC). 13 patients did not undergo any specific procedure for tumor removal and were followed clinically. RESULTS Of 13 patients not undergoing treatment, tumors disappeared in 5 cases during follow-up with diagnostic forceps biopsy. Endoscopically visible lesions remained in the last follow-up endoscopy in 8 patients (61.5%). No lymph node or distant metastases or tumor-related deaths occurred during a median follow-up of 37 months. Of 11 cases treated with EMR, tumor-free resection margins were achieved in 10 cases and no local recurrence occurred after treatment. Two perforations occurred during EMR. Of the 3 cases treated with APC, local recurrence occurred in 1 case. CONCLUSIONS Given the risks associated with EMR and the likely favorable natural history of small duodenal carcinoid tumors, conservative management with close follow-up may represent a viable alternative to endoscopic treatment, especially in patients with a high risk of perioperative complications.
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Affiliation(s)
- Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Naalla R, Konchada K, Kannappan O, Lingadakai R. Duodenal carcinoid with carcinoid syndrome. BMJ Case Rep 2014; 2014:bcr-2013-202159. [PMID: 24414187 DOI: 10.1136/bcr-2013-202159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Carcinoid tumours are uncommon well-differentiated neuroendocrine tumours. Primary duodenal carcinoids account for less than 2% of all gastrointestinal carcinoids. Duodenal carcinoids are seldom associated with carcinoid syndrome. We report a rare case of duodenal carcinoid presenting as a carcinoid syndrome in a middle-aged man with upper abdominal pain, hot flushes, diarrhoea and dry cough. Endoscopy-guided biopsy and 24 h urine 5-hydroxyindoleacetic acid (5-HIAA) proved the diagnosis. He was further evaluated and managed with definitive surgical treatment.
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Affiliation(s)
- Ravikiran Naalla
- Department of General Surgery, Kasturba Hospital, Manipal University, Manipal, Karnataka, India
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29
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Waisberg J, Joppert-Netto G, Vasconcellos C, Sartini GH, Miranda LSVD, Franco MIF. Carcinoid tumor of the duodenum: a rare tumor at an unusual site. Case series from a single institution. ARQUIVOS DE GASTROENTEROLOGIA 2013; 50:3-9. [PMID: 23657299 DOI: 10.1590/s0004-28032013000100002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 01/16/2013] [Indexed: 12/15/2022]
Abstract
CONTEXT Duodenal carcinoids are extremely rare, and their characteristics and biological behavior have not been fully elucidated. OBJECTIVE To analyze the clinicopathological characteristics of patients with resected duodenal carcinoids. METHODS Twenty patients (12 females and 8 males) were investigated. Their average age was 66.4 ± 5.8 years old (43 to 88 years old). The data corresponding to the clinical picture, diagnosis, treatment, and prognosis of patients with duodenal carcinoid tumors subjected to resection over a period of 18 years (1993-2011) were analyzed. RESULTS The most common symptoms were dyspepsia (50%) and epigastric pain (45%) followed by weight loss (10%) and vomiting (5%). Carcinoid syndrome was not observed in any patient. The lesion was located on the first part of the duodenum in 15 (75%) patients, the second part in 4 (20%) patients, and the third part in 1 (5%) patient. The diagnosis of a carcinoid tumor was established through an endoscopic excision biopsy in 19 (95%) patients and an histopathological examination of the surgical specimen in 1 (5%) patient. The average tumor size was 1.1 cm ± 0.4 cm (0.3 cm to 6.0 cm). Nineteen (95%) patients were initially treated by endoscopic resection of the duodenal lesion. One patient (5%), whose tumor was on the third part of the duodenum underwent a duodenectomy of the third and fourth duodenal parts and duodenojejunal anastomosis. The duodenal carcinoid resection margin was involved in four (20%) patients. Four (20%) patients were subjected to a partial gastrectomy to fully remove the lesion. The tumor was restricted to the submucosal layer in 16 (80%) cases, and it penetrated into the muscular layer in 4 (20%) cases. All patients exhibited positive chromogranin A, neuron-specific enolase, and/or synaptophysin immunostaining. The average duration of the follow-up period was 39.6 months (3 to 96 months). Twelve (60%) of the 20 cases in this series are alive without any evidence of active disease. Only one (5%) patient died due to liver metastases of the duodenal carcinoid. CONCLUSIONS Duodenal carcinoids are rare and indolent tumors usually associated with a benign progression. Duodenoscopy, computerized tomography, and endoscopic ultrasound should be performed to evaluate the tumor size, the level of wall invasion, and the presence of regional or distant lymphatic metastases. Endoscopic removal of tumors smaller than 1.0 cm without periampullary localization or evidence of muscular propria layer invasion assessed by histology and/or endoscopic ultrasound is recommended. The endoscopic resection with a carcinoid tumor size between 1.0 cm and 2.0 cm can be incomplete and require new endoscopic resection or even surgical removal. Duodenal carcinoid larger than 2.0 cm require full-thickness resection and concomitant lymphadenectomy.
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Affiliation(s)
- Jaques Waisberg
- Hospital do Servidor Público Estadual (IAMSPE), São Paulo, Brazil.
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30
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Boškoski I, Volkanovska A, Tringali A, Bove V, Familiari P, Perri V, Costamagna G. Endoscopic resection for gastrointestinal neuroendocrine tumors. Expert Rev Gastroenterol Hepatol 2013; 7:559-69. [PMID: 23985005 DOI: 10.1586/17474124.2013.816117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gastrointestinal (GI) and neuroendocrine tumors (NETs) can be treated by mini-invasive endoscopic resection when localized in the superficial layers of the bowel wall and their size is <20 mm. Endoscopic diagnosis of NETs is usually incidental or suspected after clinical, laboratory or imaging findings. Endoscopic mucosal resection is the most commonly used technique for NET removal, endoscopic submucosal dissection is indicated in selected cases, while papillectomy is feasible for ampullary lesions. Histopathologic assessment of the resection margin (circumferential and deep) is important for staging. Incidence of endoscopic mucosal resection-/endoscopic submucosal dissection-related complications for removal of GI NETs are similar to those reported for other GI lesions. Endoscopic follow-up is based on histopathologic characteristics of the resected NETs and its site. NETs >20 mm in size, with penetration of the muscle layer and/or serosa are at high risk for metastases and surgical approach is recommended when feasible.
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Affiliation(s)
- Ivo Boškoski
- Digestive Endoscopy Unit, Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
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Abstract
Management of patients with gastrointestinal stromal tumor (GIST) typically involves a combination of surgical, pathologic, and pharmacologic interventions. Gastroenterologists are often the first specialists to encounter patients presenting with GIST and are therefore responsible for facilitating early intervention strategies. Although patients with gastric or small-bowel GISTs typically present with symptoms, a diagnosis of GIST should be considered whenever a submucosal lesion is seen endoscopically. Visualization by standard endoscopy often can determine tumor location and size, although endoscopic ultrasound (EUS) is the most accurate imaging technique for submucosal lesions. Biopsy techniques that yield sufficient tumor samples for diagnostic studies, such as EUS-guided fine needle aspiration, are essential, although other approaches such as EUS-guided core needle biopsy may increase diagnostic yield for subepithelial lesions. Pathology assessment should include immunohistochemical staining for KIT and possibly DOG1 expression, and mutational analysis can have prognostic and predictive value for certain patients. R0 resection is the goal for patients with localized or potentially resectable tumors, which often can be accomplished by laparoscopic resection, even for larger tumors. Medical oncologists play a key role in assessing risk of recurrence after resection and optimizing tyrosine kinase inhibitor therapy in the adjuvant or metastatic setting. Cytoreductive surgery may have value for patients with recurrent or metastatic GIST who exhibit stable disease or respond to tyrosine kinase inhibitor therapy. A coordinated multidisciplinary approach over the course of the disease will serve to enhance communication among GIST team members, reduce risk of progression, and optimize outcomes.
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Hatogai K, Oono Y, Fu KI, Odagaki T, Ikematsu H, Kojima T, Yano T, Kaneko K. Unexpected endoscopic full-thickness resection of a duodenal neuroendocrine tumor. World J Gastroenterol 2013; 19:4267-4270. [PMID: 23864794 PMCID: PMC3710433 DOI: 10.3748/wjg.v19.i26.4267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 04/03/2013] [Accepted: 04/11/2013] [Indexed: 02/06/2023] Open
Abstract
A 57-year-old man underwent endoscopy for investigation of a duodenal polyp. Endoscopy revealed a hemispheric submucosal tumor, about 5 mm in diameter, in the anterior wall of the duodenal bulb. Endoscopic biopsy disclosed a neuroendocrine tumor histologically, therefore endoscopic mucosal resection was conducted. The tumor was effectively and evenly elevated after injection of a mixture of 0.2% hyaluronic acid and glycerol at a ratio of 1:1 into the submucosal layer. A small amount of indigo-carmine dye was also added for coloration of injection fluid. The lesion was completely resected en bloc with a snare after submucosal fluid injection. Immediately, muscle-fiber-like tissues were identified in the marginal area of the resected defect above the blue-colored layer, which suggested perforation. The defect was completely closed with a total of 9 endoclips, and no symptoms associated with peritonitis appeared thereafter. Histologically, the horizontal and vertical margins of the resected specimen were free of tumor and muscularis propria was also seen in the resected specimen. Generally, endoscopic mucosal resection is considered to be theoretically successful if the mucosal defect is colored blue. The blue layer in this case, however, had been created by unplanned injection into the subserosal rather than the submucosal layer.
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33
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Kimura T, Muguruma N, Goji T, Okamoto K, Kitamura S, Yano H, Miyamoto H, Okahisa T, Sakashita N, Takayama T. Pedunculated duodenal carcinoid successfully removed by endoscopic resection with endoloop. J Dig Dis 2013; 14:402-404. [PMID: 23302224 DOI: 10.1111/1751-2980.12033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Tetsuo Kimura
- Department of Gastroenterology and Oncology, University of Tokushima Graduate School, Tokushima, Japan
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Otaki Y, Homma K, Nawata Y, Imaizumi K, Arai S. Endoscopic mucosal resection with circumferential mucosal incision of duodenal carcinoid tumors. World J Gastrointest Endosc 2013; 5:197-200. [PMID: 23596546 PMCID: PMC3627846 DOI: 10.4253/wjge.v5.i4.197] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 01/07/2013] [Accepted: 01/30/2013] [Indexed: 02/06/2023] Open
Abstract
Duodenal carcinoids are a rare form of neuroendocrine tumors, and tend to invade the submucosa during the early stage. Endoscopic treatment is generally recommended for duodenal carcinoids less than 10 mm in diameter. Although a few reports have described the use of endoscopic resection of duodenal carcinoids, there are no published studies on endoscopic mucosal resection with circumferential mucosal incision (EMR-CMI). We performed EMR-CMI for 5 cases of duodenal carcinoids in the duodenal bulb. The mean tumor diameter was 4.6 ± 1.8 mm. Although all of the tumors were located in the submucosa, R0 resection was performed without complication in each case. EMR-CMI may thus be a safe and effective treatment for duodenal carcinoids less than 10 mm in diameter.
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35
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Rammohan A, Jeswanth S, Senthil Kumar P, Ravichandran P. Endoscopic Banding for Duodenal Carcinoid Tumors. Euroasian J Hepatogastroenterol 2013. [DOI: 10.5005/jp-journals-10018-1068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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36
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O'Toole D, Delle Fave G, Jensen RT. Gastric and duodenal neuroendocrine tumours. Best Pract Res Clin Gastroenterol 2012; 26:719-735. [PMID: 23582915 DOI: 10.1016/j.bpg.2013.01.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 01/10/2013] [Indexed: 01/31/2023]
Abstract
Gastric neuroendocrine neoplasms (NENs) are increasing in frequency and have a varied spectrum with regard to histology, clinicopathologic background, stage, and prognosis. They are usually discovered incidentally, are for the most part benign and are associated with hypergastrinaemia (secondary either to chronic atrophic gastritis or rarely Zollinger-Ellison syndrome; types 1 and 2, respectively) or more rarely sporadic type 3. Applications of recent staging and grading systems - namely using Ki-67 proliferative indices - (from ENETS and WHO 2010) can be particularly helpful in further categorising these tumours. The natural history of Type 1 gastric carcinoids is generally (>95%) favourable and simple surveillance is usually recommended for small (<1 cm) T1 tumours, with local (endoscopic or surgical) resection for larger lesions. Other potential therapies such as somatostatin analogues and gastrin receptor antagonists may offer newer therapeutic possibilities. Rarely, gastric NENs have a malignant course and this is usually confined to Type 2 and especially Type 3 tumours; the latter mimic the biological course of gastric adenocarcinoma and require radical oncological therapies. Most duodenal NENs, apart from gastrinomas (that are not dealt with here) are sporadic and non functional. They are also increasing in frequency probably due to incidental discovery at endoscopy or imaging for other reasons and this may account for their overall good prognosis. Peri-ampullary and ampullary NENs may have a more aggressive outcome and should be carefully appraised and treated (often with surgical resection).
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Affiliation(s)
- Dermot O'Toole
- Department of Gastroenterology and Clinical Medicine, St James's Hospital and Trinity College, Dublin, Ireland.
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37
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Li QL, Zhang YQ, Chen WF, Xu MD, Zhong YS, Ma LL, Qin WZ, Hu JW, Cai MY, Yao LQ, Zhou PH. Endoscopic submucosal dissection for foregut neuroendocrine tumors: An initial study. World J Gastroenterol 2012; 18:5799-806. [PMID: 23155323 PMCID: PMC3484351 DOI: 10.3748/wjg.v18.i40.5799] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 05/31/2012] [Accepted: 06/08/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the feasibility and efficacy of endoscopic submucosal dissection (ESD) for foregut neuroendocrine tumors (NETs).
METHODS: From April 2008 to December 2010, patients with confirmed histological diagnosis of foregut NETs were included. None had regional lymph node enlargement or distant metastases to the liver or lung on preoperative computerized tomography scanning or endoscopic ultrasonography (EUS). ESD was attempted under general anesthesia. After making several marking dots around the lesion, a mixture solution was injected into the submucosa. The mucosa was incised outside the marking dots. Dissection of the submucosal layer beneath the tumor was performed under direct vision to achieve complete en bloc resection of the specimen. Tumor features, clinicopathological characteristics, complete resection rate, and complications were evaluated. Foregut NETs were graded as G1, G2, or G3 on the basis of proliferative activity by mitotic count or Ki-67 index. All patients underwent regular follow-up to evaluate for any local recurrence or distant metastasis.
RESULTS: Those treated by ESD included 24 patients with 29 foregut NETs. The locations of the 29 lesions are as follows: esophagus (n = 1), cardia (n = 1), stomach (n = 23), and duodenal bulb (n = 4). All lesions were found incidentally during routine upper gastrointestinal endoscopy for other indications, and none had symptoms of carcinoid syndrome. Preoperative EUS showed that all tumors were confined to the submucosa. Among the 24 gastric lesions, 16 lesions in 11 patients were type I gastric NETs arising in chronic atrophic gastritis with hypergastrinemia, while the other 8 solitary lesions were type III because of absence of atrophic gastritis in these cases. All of the tumors were removed in an en bloc fashion. The average maximum diameter of the lesions was 9.4 mm (range: 2-30 mm), and the procedure time was 20.3 min (range: 10-45 min). According to the World Health Organization 2010 classification, histological evaluation determined that 26 lesions were NET-G1, 2 gastric lesions were NET-G2, and 1 esophageal lesion was neuroendocrine carcinoma (NEC). Complete resection was achieved in 28 lesions (28/29, 96.6%), and all of them were confined to the submucosa in histopathologic assessment with no lymphovascular invasion. The remaining patient with NEC underwent additional surgery because the resected specimens revealed angiolymphatic and muscularis invasion, as well as incomplete resection. Delayed bleeding occurred in 1 case 3 d after ESD, which was managed by endoscopic treatment. There were no procedure-related perforations. During a mean follow-up period of 24.4 mo (range: 12-48 mo), local recurrence occurred in only 1 patient 7 mo after initial ESD. This patient successfully underwent repeat ESD. Metastasis to lymph nodes or distal organs was not observed in any patient. No patients died during the study period.
CONCLUSION: ESD appears to be a safe, feasible, and effective procedure for providing accurate histopathological evaluations and curative treatment for eligible foregut NETs.
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Abe N, Takeuchi H, Shibuya M, Ohki A, Yanagida O, Masaki T, Mori T, Sugiyama M. Successful treatment of duodenal carcinoid tumor by laparoscopy-assisted endoscopic full-thickness resection with lymphadenectomy. Asian J Endosc Surg 2012; 5:81-5. [PMID: 22776369 DOI: 10.1111/j.1758-5910.2011.00120.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Reports on endoscopic full-thickness resection of the duodenum using the endoscopic submucosal dissection technique are rare. Here we present a case of a duodenal bulb carcinoid tumor successfully treated by laparoscopy-assisted endoscopic full-thickness resection (LAEFR). An asymptomatic 65-year-old woman had a 10-mm, submucosal tumor on the anterior wall of the duodenal bulb. Abdominal CT revealed an enlarged lymph node adjacent to the duodenum and pancreas. Although we informed the patient of the need for pancreatoduodenectomy with a lymphadenectomy, the patient expressly requested LAEFR. After negative nodal metastasis was confirmed by an intraoperative frozen section of the enlarged nodes, LAEFR was performed using the endoscopic submucosal dissection technique under the laparoscopic assistance. The duodenal wall defect was closed by laparoscopy with an Albert anastomosis. The entire circumferential margin of the specimen was histopathologically negative for carcinoid tumor cells. In summary, LAEFR enables en bloc and whole-layer excision of nonperiampullary duodenal lesions with a sufficient surgical margin, both vertically and laterally. LAEFR is a minimally invasive and effective treatment for selected patients with duodenal carcinoid tumor.
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Affiliation(s)
- N Abe
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan.
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Abstract
Duodenal polyps are a rare finding in patients presenting for gastroscopy, being found in 0.3-4.6% of cases. The majority of patients are asymptomatic. The most common lesions necessitating removal are duodenal adenomas which should be differentiated from other mucosal lesions such as ectopic gastric mucosa, and submucosal lesions such as carcinoids and gastrointestinal stromal tumours (GISTs). Adenomas can occur sporadically or as part of a polyposis syndrome. Both groups carry malignant potential but this is higher in patients with a polyposis syndrome. The majority of sporadic duodenal adenomas are flat or sessile and occur in the second part of the duodenum. Historically duodenal adenomas have been managed by radical surgery, which carried significant mortality and morbidity, or more conservative local surgical excision which resulted in high local recurrence rates. There is growing evidence for the use of endoscopic mucosal resection (EMR) techniques for treatment of sporadic nonampullary duodenal adenomas, with good outcomes and low complication rates. Endoscopic submucosal dissection (ESD) carries greater risk of complications and should be reserved for experts in this technique. Patients with sporadic duodenal adenomas carry an increased risk of colonic neoplasia and should be offered colonoscopy. The impact of endoscopic resection on the course of polyposis syndromes such as familial adenomatous polyposis (FAP) needs further study.
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Affiliation(s)
- Peter John Basford
- Portsmouth Hospitals NHS Trust – Gastroenterology, Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | - Pradeep Bhandari
- Department of Gastroenetrology, Queen Alexandra Hospital, Portsmouth, UK
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Delle Fave G, Kwekkeboom DJ, Van Cutsem E, Rindi G, Kos-Kudla B, Knigge U, Sasano H, Tomassetti P, Salazar R, Ruszniewski P. ENETS Consensus Guidelines for the management of patients with gastroduodenal neoplasms. Neuroendocrinology 2012; 95:74-87. [PMID: 22262004 DOI: 10.1159/000335595] [Citation(s) in RCA: 211] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Matsumoto S, Miyatani H, Yoshida Y, Nokubi M. Duodenal carcinoid tumors: 5 cases treated by endoscopic submucosal dissection. Gastrointest Endosc 2011; 74:1152-1156. [PMID: 21944312 DOI: 10.1016/j.gie.2011.07.029] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 07/01/2011] [Indexed: 12/13/2022]
Affiliation(s)
- Satohiro Matsumoto
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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42
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Yokoyama S, Takifuji K, Tani M, Kawai M, Naka T, Uchiyama K, Yamaue H. Endoscopic resection of duodenal bulb neuroendocrine tumor larger than 10 mm in diameter. BMC Gastroenterol 2011; 11:67. [PMID: 21658277 PMCID: PMC3123295 DOI: 10.1186/1471-230x-11-67] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 06/10/2011] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Endoscopic treatment for duodenal bulb neuroendocrine tumor larger than 10 mm is still controversial. This report presents four cases successfully treated with endosonography (EUS)-assisted endoscopic mucosal resection (EMR) procedure for duodenal bulb neuroendocrine tumor larger than 10 mm in diameter. METHODS The case series of four patients diagnosed with neuroendocrine tumor from 2003 to 2008 were reviewed. EUS demonstrated well-defined hypoechoic tumors confined to the submucosal hyperechoic layer and the underlying hypoechoic muscularis propria was intact in all four patients. EMR were planned and performed for the duodenal bulb neuroendocrine tumors larger than 10 mm. RESULTS En bloc resections with tumor free lateral and basal margins were accomplished using an endoscopic diathermic snare with forward-viewing instruments without any complications. Neither residual duodenal neuroendocrine tumors nor metastatic lesions were detected during the observation period ranging 19 to 78 months CONCLUSION Duodenal bulb neuroendocrine, larger than 10 mm in diameter, can be treated by endoscopic procedure, after confirming that the tumor confined to the submucosal layer in EUS examination, and no lymph node involvement by abdominal CT and US.
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Affiliation(s)
- Shozo Yokoyama
- Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - Katsunari Takifuji
- Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - Masaji Tani
- Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - Manabu Kawai
- Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - Teiji Naka
- Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - Kazuhisa Uchiyama
- Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan
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Ishido K, Tanabe S, Higuchi K, Sasaki T, Katada C, Azuma M, Naruke A, Koizumi W, Mikami T. Clinicopathological evaluation of duodenal well-differentiated endocrine tumors. World J Gastroenterol 2010; 16:4583-8. [PMID: 20857530 PMCID: PMC2945491 DOI: 10.3748/wjg.v16.i36.4583] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the clinicopathological characteristics of duodenal well-differentiated endocrine tumors.
METHODS: We examined clinicopathological characteristics in 11 consecutive patients with duodenal well-differentiated endocrine tumors treated by endoscopic therapy or surgery in our hospital from 1992 through 2007. Patients with well-differentiated endocrine tumors of the papilla of Vater or with gastrinoma were excluded.
RESULTS: Three patients received endoscopic treatment, and 8 underwent surgery. In patients who received endoscopic treatment, the tumor diameter was less than 1.0 cm, with no histopathological evidence of lymphovascular invasion or invasion of the muscularis. There were no complications such as late bleeding or perforation after treatment. Among 8 patients with tumors less than 1.0 cm in diameter, 3 underwent partial resection, and 2 underwent radical surgery. Three patients had lymphovascular invasion, 1 had invasion of the muscularis, and 1 had proximal lymph node metastasis. Among 3 patients with tumors 1.0 cm or more in diameter, 1 underwent partial resection, and 2 underwent radical surgery. One patient had lymphovascular invasion, with no lymph node metastasis. After treatment, all patients are alive and have remained free of metastasis and recurrence.
CONCLUSION: Duodenal well-differentiated endocrine tumors less than 1.0 cm in diameter have a risk of lymphovascular invasion, invasion of the muscularis, and lymph node metastasis, irrespective of procedural problems.
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Kim SY, Jung SW, Lee SW. [A case of easily overlooked small duodenal carcinoid tumor]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2009; 54:265-7. [PMID: 19934607 DOI: 10.4166/kjg.2009.54.5.265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Seung Young Kim
- Department of Internal Medicine, Institute of Digestive Diseases and Nutrition, Korea University College of Medicine, Seoul, Korea
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Tai WP, Yue H. Endoscopic mucosa resection of a duodenum carcinoid tumor of 1.2 cm diameter: a case report. Med Oncol 2008; 26:319-21. [DOI: 10.1007/s12032-008-9123-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Accepted: 10/23/2008] [Indexed: 10/24/2022]
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Jensen RT, Rindi G, Arnold R, Lopes JM, Brandi ML, Bechstein WO, Christ E, Taal BG, Knigge U, Ahlman H, Kwekkeboom DJ, O'Toole D. Well-differentiated duodenal tumor/carcinoma (excluding gastrinomas). Neuroendocrinology 2007; 84:165-172. [PMID: 17312376 DOI: 10.1159/000098008] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Cantor MJ, Davila RE, Faigel DO. Yield of tissue sampling for subepithelial lesions evaluated by EUS: a comparison between forceps biopsies and endoscopic submucosal resection. Gastrointest Endosc 2006; 64:29-34. [PMID: 16813799 DOI: 10.1016/j.gie.2006.02.027] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Accepted: 02/03/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND In most circumstances, subepithelial tumors lack distinct endoscopic and ultrasonographic features. Consequently, definitive diagnosis usually requires tissue acquisition and pathologic confirmation. Establishing a tissue diagnosis is difficult because the yield of forceps biopsies is low. However, prospective data evaluating tissue sampling techniques for subepithelial lesions are currently lacking. OBJECTIVE Our purpose was to prospectively determine the diagnostic yield of endoscopic submucosal-mucosal resection (ESMR) compared with forceps biopsy for lesions limited to the submucosa (third endosonographic layer) of the GI tract. DESIGN A prospective head-to-head comparison was performed. SETTING The study was performed in a tertiary care hospital. PATIENTS Study patients were 23 adults with subepithelial lesions limited to the submucosa. INTERVENTION All submucosal lesions underwent forceps biopsy followed by endoscopic submucosal resection. Biopsy specimens were obtained with large-capacity "jumbo" forceps. A total of 4 double passes (8 biopsy specimens) were collected from each lesion with use of the bite-on-bite technique. Endoscopic resection was then performed with an electrosurgical snare or cap-fitted endoscopic mucosal resection device. MAIN OUTCOME MEASUREMENT The main outcome measurement was the diagnostic yield of biopsy forceps compared with endoscopic submucosal resection. RESULTS Twenty-three patients with lesions limited to the submucosa were identified by endoscopic ultrasonography. All lesions underwent forceps biopsy followed by ESMR. The diagnostic yield of the jumbo forceps biopsy was 4 of 23 (17%), whereas the diagnostic yield of ESMR was 20 of 23 (87%) (P = .0001, McNemar test). CONCLUSION In the evaluation of subepithelial lesions limited to the submucosa, ESMR has a significantly higher diagnostic yield than jumbo forceps biopsy with use of the bite-on-bite technique.
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Affiliation(s)
- Michael J Cantor
- Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA
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Hoffmann KM, Furukawa M, Jensen RT. Duodenal neuroendocrine tumors: Classification, functional syndromes, diagnosis and medical treatment. Best Pract Res Clin Gastroenterol 2005; 19:675-697. [PMID: 16253893 DOI: 10.1016/j.bpg.2005.05.009] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Duodenal neuroendocrine tumors (NETs) comprise 2-3% of all GI endocrine tumors and are increasing in frequency. These include gastrinomas, somatostatinomas, nonfunctional NETs, gangliocytic paragangliomas, and poorly differentiated NE carcinomas. Although, the majority are nonfunctional, these tumors are a frequent cause of Zollinger-Ellison syndrome and can cause other clinical hormonal syndromes (carcinoid, Cushing's, etc.). In this chapter, their epidemiology, clinical aspects, localization, diagnosis and medical treatment are reviewed including the latest advances in each area.
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Affiliation(s)
- K Martin Hoffmann
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bldg. 10, Rm. 9C-103, 10 Center Dr, MSC 1804, Bethesda, MD 20892-1804, USA
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Linares Torres P, Castañón López AM, Romero Arauzo MJ, Pérez-Miranda Castillo M, Rodríguez Díez R, Alonso Fernández A, Dajil SEM. [Utility of echoendoscopy for endoscopic resection of duodenal carcinoid tumors]. GASTROENTEROLOGIA Y HEPATOLOGIA 2005; 28:309. [PMID: 15871820 DOI: 10.1157/13074071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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