Skip to main content
SpringerLink
Log in

Outcomes of Surgical and Endoscopic Resection of Duodenal Neuroendocrine Tumours (NETs): a Systematic Review of the Literature

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Duodenal neuroendocrine tumours (dNETs) comprise about 2% of all the NETs. Treatment of dNETs involves resection of the tumour either by endoscopic or surgical resection. Surgical or endoscopic local resection of the lesion is usually a more conservative and less morbid option compared with a more radical pancreaticoduodenectomy. However, inadequate clearance by local resection might result in recurrent disease with reduced overall survival.

Methods

The current systematic review compared the differences in outcomes of endoscopic resection (ER), local resection (LR) and pancreaticoduodenectomy (PD) in the management of dNETs. Searches were performed on MEDLINE, PubMed, Embase and Cochrane databases using MeSH keyword combinations: ‘duodenal’, AND, ‘neuroendocrine tumours’. All relevant articles published up to 2016 were included. Post-operative morbidity, R0 resection status and recurrence rates were the outcomes assessed.

Results

Eight non-randomised retrospective studies with 335 participants were included (LR = 122; PD = 118; ER = 64). While PD was associated with higher morbidity compared with LR (27/64 vs. 10/74; P = 0.002), PD was associated with a higher incidence of an R0 resection (3/97 vs. 15/97; P = 0.007) as well as lower recurrence rates (3/51 vs. 6/46; P = 0.21). ER was associated with a higher positive resection margin status versus LR (22/51 vs. 14/91; P = 0.0002). Recurrence at follow-up was not different among patients with dNETs who underwent PD versus LR.

Conclusions

Radical surgical resection in the form of PD was associated with higher post-operative morbidity among patients with dNETs yet provided better margin clearance. Patients with dNETs need systematic evaluation with a view to obtain most of the information about the prognostic factors in order to tailor the treatment options.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Yao JC, Hassan M, Phan A, Dagohoy C, Leary C, Mares JE, et al. One Hundred Years After “Carcinoid”: Epidemiology of and Prognostic Factors for Neuroendocrine Tumors in 35,825 Cases in the United States. J Clin Oncol. 2008 Jun 20;26(18):3063–72.

    Article  PubMed  Google Scholar 

  2. Shroff SR, Kushnir VM, Wani SB, Gupta N, Jonnalagadda SS, Murad F, et al. Efficacy of Endoscopic Mucosal Resection for Management of Small Duodenal Neuroendocrine Tumors. Surg Laparosc Endosc Percutan Tech. 2015 Oct;25(5):e134–9.

    Article  PubMed  Google Scholar 

  3. Min B-H, Kim ER, Lee JH, Kim K-M, Min YW, Rhee P-L, et al. Management Strategy for Small Duodenal Carcinoid Tumors: Does Conservative Management with Close Follow-Up Represent an Alternative to Endoscopic Treatment. Digestion. 2013;87(4): 247–53.

    Article  PubMed  CAS  Google Scholar 

  4. Delle Fave G, Kwekkeboom DJ, Van Cutsem E, Rindi G, Kos-Kudla B, Knigge U, et al. ENETS Consensus Guidelines for the Management of Patients with Gastroduodenal Neoplasms. Neuroendocrinology. 2012;95(2):74–87.

    Article  PubMed  CAS  Google Scholar 

  5. Min BH, Kim ER, Lee JH, Kim KM, Min YW, Rhee PL, et al. Management strategy for small duodenal carcinoid tumors: Does conservative management with close follow-up represent an alternative to endoscopic treatment? Digestion. 2013;87(4):247–53.

    Article  PubMed  CAS  Google Scholar 

  6. Witzigmann H, Loracher C, Geissler F, Wagner T, Tannapfel A, Uhlmann D, et al. Neuroendocrine tumours of the duodenum: Clinical aspects, pathomorphology and therapy. Langenbeck’s Arch Surg. 2002;386(7):525–33.

    Article  Google Scholar 

  7. Ricci JL. Carcinoid of the ampulla of Vater. Local resection or pancreaticoduodenectomy. Cancer. 1993 Feb 1;71(3):686–90.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  9. Soga J. Early-stage carcinoids of the gastrointestinal tract: an analysis of 1914 reported cases. Cancer. 2005 Apr 15;103(8):1587–95.

    Article  PubMed  Google Scholar 

  10. Zyromski NJ, Kendrick ML, Nagorney DM, Grant CS, Donohue JH, Farnell MB, et al. Duodenal carcinoid tumors: how aggressive should we be? J Gastrointest Surg. 5(6):588–93.

  11. Hartel M, Wente MN, Sido B, Friess H, Büchler MW. Carcinoid of the ampulla of Vater. J Gastroenterol Hepatol. 2005 May;20(5):676–81.

    Article  PubMed  Google Scholar 

  12. Randle RW, Ahmed S, Newman NA, Clark CJ. Clinical outcomes for neuroendocrine tumors of the duodenum and ampulla of Vater: a population-based study. J Gastrointest Surg. 2014 Feb 10;18(2):354–62.

    Article  PubMed  Google Scholar 

  13. Margonis GA, Samaha M, Kim Y, Postlewait LML, Kunz P, Maithel S, et al. A Multi-institutional Analysis of Duodenal Neuroendocrine Tumors: Tumor Biology Rather than Extent of Resection Dictates Prognosis. J Gastrointest Surg. 2016;20(6):1098–105.

    Article  PubMed  Google Scholar 

  14. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series. Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series. 2008. 1–649 p.

  15. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. Vol. 4, The Cochrane Collaboration. 2011.

  16. Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med. 1998 Dec 30;17(24):2815–34.

    Article  PubMed  CAS  Google Scholar 

  17. Ishido K, Tanabe S, Higuchi K, Sasaki T, Katada C, Azuma M, et al. Clinicopathological evaluation of duodenal well-differentiated endocrine tumors. World J Gastroenterol. 2010;16(36):4583–8.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Weatherall T, Denbo J, Sharpe J, Martin M, O’Brien T, Gupta R, et al. Well-Differentiated, Non-Functional, Non-Ampullary Duodenal Neuroendocrine Tumors: Toward Defining Evaluation and Management. World J Surg. 2017;41(3):844–50.

    Article  PubMed  Google Scholar 

  19. Gincul R, Ponchon T, Napoleon B, Scoazec J-Y, Guillaud O, Saurin J-C, et al. Endoscopic treatment of sporadic small duodenal and ampullary neuroendocrine tumors. Endoscopy. 2016 Aug 5;48(11):979–86.

    Article  PubMed  Google Scholar 

  20. Iwasaki T, Nara S, Kishi Y, Esaki M, Shimada K, Hiraoka N. Surgical treatment of neuroendocrine tumors in the second portion of the duodenum: a single center experience and systematic review of the literature. Langenbeck’s Arch Surg. Langenbeck’s Archives of Surgery; 2017;402(6):925–33.

    Article  Google Scholar 

  21. Untch BR, Bonner KP, Roggin KK, Reidy-Lagunes D, Klimstra DS, Schattner MA, et al. Pathologic Grade and Tumor Size are Associated with Recurrence-Free Survival in Patients with Duodenal Neuroendocrine Tumors. J Gastrointest Surg. 2014;18(3):457–63.

    Article  PubMed  Google Scholar 

  22. Baptiste GG, Postlewait LM, Ethun CG, Le N, Russell MC, Kooby DA, et al. Is there an Optimal Surgical Approach to Neuroendocrine Tumors of the Ampulla? A Single Institution Experience Over 15 Years. Am Surg. 2016 Jul;82(7):637–43.

    PubMed  Google Scholar 

  23. Burke CA, Beck GJ, Church JM, van Stolk RU. The natural history of untreated duodenal and ampullary adenomas in patients with familial adenomatous polyposis followed in an endoscopic surveillance program. Gastrointest Endosc. 1999 Mar;49(3 Pt 1):358–64.

    Article  PubMed  CAS  Google Scholar 

  24. Makhlouf HR, Burke AP, Sobin LH. Carcinoid tumors of the ampulla of Vater: a comparison with duodenal carcinoid tumors. Cancer. 1999 Mar 15;85(6):1241–9.

    Article  PubMed  CAS  Google Scholar 

  25. Bornstein-Quevedo L, Gamboa-Domínguez A. Carcinoid tumors of the duodenum and ampulla of vater: a clinicomorphologic, immunohistochemical, and cell kinetic comparison. Hum Pathol. 2001 Nov;32(11):1252–6.

    Article  PubMed  CAS  Google Scholar 

  26. Cameron JL, Riall TS, Coleman J, Belcher KA. One Thousand Consecutive Pancreaticoduodenectomies. Ann Surg. 2006 Jul;244(1):10–5.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Huang JJ, Yeo CJ, Sohn TA, Lillemoe KD, Sauter PK, Coleman J, et al. Quality of life and outcomes after pancreaticoduodenectomy. Ann Surg. 2000 Jun;231(6):890–8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  28. Chen G, Liu S, Zhao Y, Dai M, Zhang T. Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for pancreatic cancer: A meta-analysis. Pancreatology. 2013 May;13(3):298–304.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of HPB and Liver Transplantation Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2TH, UK

    Bobby V. M. Dasari, Sarah Al-Shakhshir, Ravi Marudanayagam, Robert P. Sutcliffe, Darius F. Mirza, Paolo Muiesan, Keith J. Roberts & John Isaac

  2. Department of Surgery, Division of Surgical Oncology, The Ohio State University, Wexner Medical Centre, Columbus, OH, USA

    Timothy M. Pawlik

  3. Department of Hepatology and Centre for Neuroendocrine Tumours, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK

    Tahir Shah

Authors
  1. Bobby V. M. Dasari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah Al-Shakhshir
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Timothy M. Pawlik
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tahir Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ravi Marudanayagam
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert P. Sutcliffe
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Darius F. Mirza
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Paolo Muiesan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Keith J. Roberts
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. John Isaac
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception or design of the work: BD, TS.

Acquisition, analysis of the work: BD, TP, and SA.

Interpretation of data for the work: BD, TP, SA, TS, RS, RM, DM, PM, KR, JI.

Drafting the work or revising it critically for important intellectual content: BD, TP, SA, TS, RS, RM, DM, PM, KR, JI.

Final approval of the version to be published: BD, TP, SA, TS, RS, RM, DM, PM, KR, JI.

Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: BD, TP, SA, TS, RS, RM, DM, PM, KR, JI.

Corresponding author

Correspondence to Bobby V. M. Dasari.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dasari, B.V.M., Al-Shakhshir, S., Pawlik, T.M. et al. Outcomes of Surgical and Endoscopic Resection of Duodenal Neuroendocrine Tumours (NETs): a Systematic Review of the Literature. J Gastrointest Surg 22, 1652–1658 (2018). https://doi.org/10.1007/s11605-018-3825-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-018-3825-7

Keywords

Search

Navigation