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

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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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Authors and Affiliations

  1. Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Toshimitsu Iwasaki, Satoshi Nara, Yoji Kishi, Minoru Esaki & Kazuaki Shimada

  2. Division of Pathology and Clinical Laboratories, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Nobuyoshi Hiraoka

Authors
  1. Toshimitsu Iwasaki
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  2. Satoshi Nara
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  4. Minoru Esaki
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Correspondence to Satoshi Nara.

Ethics declarations

None of the authors have conflicts of interest associated with the publication of this article. Because our institutional review board approves the conduction of retrospective cohort studies on an occasional basis, the present study was exempt from obtaining additional statements of informed consent from each patient. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Iwasaki, T., Nara, S., Kishi, Y. et al. Surgical treatment of neuroendocrine tumors in the second portion of the duodenum: a single center experience and systematic review of the literature. Langenbecks Arch Surg 402, 925–933 (2017). https://doi.org/10.1007/s00423-016-1537-6

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