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Langenbeck's Archives of Surgery

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01-09-2017 | ORIGINAL ARTICLE

Surgical treatment of neuroendocrine tumors in the second portion of the duodenum: a single center experience and systematic review of the literature

Authors: Toshimitsu Iwasaki, Satoshi Nara, Yoji Kishi, Minoru Esaki, Kazuaki Shimada, Nobuyoshi Hiraoka

Published in: Langenbeck's Archives of Surgery | Issue 6/2017

Abstract

Purpose

The treatment of choice for duodenal neuroendocrine tumors (NETs) ranges from endoscopic resection and local excision to pancreaticoduodenectomy. The aim of this study was to investigate the optimal treatment for this tumor.

Methods

We retrospectively analyzed the clinicopathological data of 14 patients with NETs in the second portion of the duodenum who underwent surgery in our hospital from 2000 to 2015. The duodenal NETs were classified as either ampullary or non-ampullary. Additionally, a systematic review and pooled analysis was conducted.

Results

Among eight patients with ampullary NETs and six patients with non-ampullary NETs, seven and three patients underwent pancreaticoduodenectomy and one and three patients underwent local resection, respectively. The maximum tumor diameter were 11–30 mm in ampullary and 10–100 mm in non-ampullary NETs, respectively. In patients with ampullary NETs, lymph node metastases were suspected in only three cases preoperatively, but five patients actually had regional nodal metastases. Among patients with non-ampullary NETs, lymph node metastases were suspected in none preoperatively, but three of the four patients who underwent lymph node dissection had regional nodal metastases. According to a pooled analysis of 1245 patients in 88 studies, even small tumors confined to the submucosal layer and G1 tumors—ampullary and non-ampullary—have been associated with lymph node metastases. In patients with non-ampullary NETs and lymph node metastasis, 10-year recurrence-free survival rate was 51% for patients who underwent pancreaticoduodenectomy (n = 19) and 53% for patients who underwent partial duodenal resection (n = 9), respectively (p = 0.960).

Conclusion

Lymph node metastases were common in association with both ampullary and non-ampullary NETs, and it was difficult to radiologically diagnose metastases. Additionally, there were no clinicopathological factors that could reliably predict the absence of lymph node metastases preoperatively. Therefore, to maximize the ability to achieve a curative resection, pancreaticoduodenectomy is considered appropriate in well-conditioned patients with NETs in the second portion of the duodenum. However, to further clarify the impact of lymph node dissection on survival after duodenal NET resection, a multi-institutional study with a large number of patients, thorough examination of lymph node metastasis, and a long observation period is warranted.

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Title: Surgical treatment of neuroendocrine tumors in the second portion of the duodenum: a single center experience and systematic review of the literature
Authors: Toshimitsu Iwasaki
Satoshi Nara
Yoji Kishi
Minoru Esaki
Kazuaki Shimada
Nobuyoshi Hiraoka
Publication date: 01-09-2017
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 6/2017
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-016-1537-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Surgical treatment of neuroendocrine tumors in the second portion of the duodenum: a single center experience and systematic review of the literature

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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