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Neuroendocrine Tumors in Meckel’s Diverticulum: Recommendation for Lymphadenectomy Regardless of Tumor Size Based on the NCDB Experience

  • Epameinondas Dogeas
  • Maximiliano Magallanes
  • Matthew R. Porembka
  • Sam C. Wang
  • Adam C. Yopp
  • Patricio M. Polanco
  • John C. Mansour
  • Michael A. Choti
  • Herbert J. ZehIII
  • Mathew M. AugustineEmail author
2018 SSAT Poster Presentation
  • 16 Downloads

Abstract

Background

Meckel’s diverticulum (MD) is an anomaly of the small intestine from which malignancy may arise. Among MD neoplasms, neuroendocrine tumors (NETs) are considered the most common. However, their metastatic potential and optimal surgical therapy remain ill-defined.

Methods

In a retrospective analysis of the National Cancer Database (2004–2015), patients with a diagnosis of MD malignancy were identified. Clinicopathologic factors were extracted and tumors arising in MD were compared. In the subgroup of patients with NET, the association between tumor factors and node involvement was investigated.

Results

Three hundred twenty primary MD malignancies were captured in the National Cancer Database, consisting of 280 (87.5%) NET. The median age at diagnosis was 64 years. Patients were predominantly male (207, 73.9%) and white (269, 96.1%). Most tumors were well-differentiated (118, 42.1%) and sub-centimeter (median size, 0.7 cm). Distant metastasis was present in a minority (16, 5.7%), and the median overall survival was 114 months in the entire cohort. The regional lymph node status was known in 87 NET patients, out of which 39 (44.8%) harbored node metastasis. Although the risk of node involvement increased with larger tumor size, it remained significant even among sub-centimeter (9 out of 34, 26.5%) and well-differentiated (18 out of 44, 41%) tumors. Regional node involvement was associated with the presence of distant metastasis (p < 0.001).

Conclusion

Lymph node involvement was common irrespective of the size and grade of NET arising from Meckel’s diverticulum. Therefore, regional lymphadenectomy should be considered in the curative-intent surgical management of these neoplasms regardless of tumor size and grade.

Keywords

Neuroendocrine tumors Carcinoid Meckel’s diverticulum Small bowel Small intestine Lymphadenectomy Lymph nodes 

Notes

Authors’ Contributions

Design of the work: Dogeas, Magallanes, Augustine

Acquisition of data: Dogeas, Magallanes, Augustine

Interpretation of data: Dogeas, Magallanes, Porembka, Wang, Yopp, Polanco, Mansour, Choti, Zeh, Augustine

Drafting the work: Dogeas, Magallanes, Augustine

Final approval: Dogeas, Magallanes, Porembka, Wang, Yopp, Polanco, Mansour, Choti, Zeh, Augustine

Agreement to be accountable for all aspects of the work: Dogeas, Magallanes, Porembka, Wang, Yopp, Polanco, Mansour, Choti, Zeh, Augustine

Compliance with Ethical Standards

Sources of Support

None.

Disclosure of Funding

None.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Epameinondas Dogeas
    • 1
  • Maximiliano Magallanes
    • 1
  • Matthew R. Porembka
    • 1
  • Sam C. Wang
    • 1
  • Adam C. Yopp
    • 1
  • Patricio M. Polanco
    • 1
  • John C. Mansour
    • 1
  • Michael A. Choti
    • 2
  • Herbert J. ZehIII
    • 1
  • Mathew M. Augustine
    • 1
    Email author
  1. 1.Division of Surgical Oncology, Harold C. Simmons Cancer Center, Department of SurgeryUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Department of SurgeryBanner MD Anderson Cancer CenterGilbertUSA

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