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01-08-2017 | Original Article

Duodenal and Ampullary Carcinoid Tumors: Size Predicts Necessity for Lymphadenectomy

Authors: Epameinondas Dogeas, John L. Cameron, Cristopher L. Wolfgang, Kenzo Hirose, Ralph H. Hruban, Martin A. Makary, Timothy A. Pawlik, Michael A. Choti

Published in: Journal of Gastrointestinal Surgery | Issue 8/2017

Abstract

Background

Unlike other neuroendocrine tumors of the gastrointestinal tract, management of duodenal and periampullary carcinoids remains controversial. We aimed to determine the metastatic potential and optimal choice of therapy for these neoplasms.

Methods

A retrospective review of all patients treated at the Johns Hopkins Hospital between 1996 and 2012 was conducted. Clinicopathologic factors associated with lymph nodal involvement and clinical outcomes were evaluated.

Results

A total of 101 patients were identified. Eighty (79.2%) tumors arose from the duodenum and 21 (20.8%) from the periampullary area. Thirty-five (34.7%) patients underwent pancreaticoduodenectomy (PD), 12 (11.9%) local resection, 38 (37.6%) endoscopic excision, and 16 (15.8%) patients harbored incidental tumors identified in the specimen after PD for another indication. Lymph node (LN) pathologic evaluation was done in 56 patients, among which 27 (48%) had positive LN. Specifically, LN positivity (LN+) for tumors <1 cm in size was 4.5% (1/22), for tumors 1–2 cm 72% (13/18), and for tumors >2 cm 81% (13/16). Tumor size was the only factor associated with LN+ (p = 0.029).

Conclusion

Lymph nodal involvement is common for duodenal and periampullary carcinoid tumors, particularly among those >1 cm in size; therefore, resection with lymphadenectomyfor these larger tumors is recommended.

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Title: Duodenal and Ampullary Carcinoid Tumors: Size Predicts Necessity for Lymphadenectomy
Authors: Epameinondas Dogeas
John L. Cameron
Cristopher L. Wolfgang
Kenzo Hirose
Ralph H. Hruban
Martin A. Makary
Timothy A. Pawlik
Michael A. Choti
Publication date: 01-08-2017
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 8/2017
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-017-3448-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Duodenal and Ampullary Carcinoid Tumors: Size Predicts Necessity for Lymphadenectomy

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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