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A Multi-institutional Analysis of Duodenal Neuroendocrine Tumors: Tumor Biology Rather than Extent of Resection Dictates Prognosis

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Journal of Gastrointestinal Surgery Aims and scope

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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Authors and Affiliations

  1. Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA

    Georgios Antonios Margonis, Mario Samaha, Yuhree Kim & Timothy M. Pawlik

  2. Department of Surgery, Emory University, Atlanta, GA, USA

    Lauren McLendon Postlewait & Shishir Maithel

  3. Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Pamela Kunz & Thuy Tran

  4. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Nickolas Berger & T. Clark Gamblin

  5. Department of Surgery, University of Virginia, Charlottesville, VA, USA

    Matthew G. Mullen & Todd W. Bauer

Authors
  1. Georgios Antonios Margonis
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  2. Mario Samaha
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  3. Yuhree Kim
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  4. Lauren McLendon Postlewait
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  5. Pamela Kunz
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  6. Shishir Maithel
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  7. Thuy Tran
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  8. Nickolas Berger
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  9. T. Clark Gamblin
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  10. Matthew G. Mullen
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  12. Timothy M. Pawlik
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Correspondence to Timothy M. Pawlik.

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Margonis, G.A., Samaha, M., Kim, Y. et al. A Multi-institutional Analysis of Duodenal Neuroendocrine Tumors: Tumor Biology Rather than Extent of Resection Dictates Prognosis. J Gastrointest Surg 20, 1098–1105 (2016). https://doi.org/10.1007/s11605-016-3135-x

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  • DOI: https://doi.org/10.1007/s11605-016-3135-x

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