Skip to main content
SpringerLink
Log in

Tumor Size and Depth Predict Rate of Lymph Node Metastasis and Utilization of Lymph Node Sampling in Surgically Managed Gastric Carcinoids

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Radical resection with regional lymphadenectomy is recommended for all sporadic gastric carcinoids. Local resection, however, is accepted for some carcinoids from other gastrointestinal sites (i.e., appendix and rectum). We sought to examine the relation of tumor size and depth to lymph node metastasis to determine whether gastric carcinoids can be selected for endoscopic resection. We also sought to quantify the utilization of lymph node sampling.

Methods

984 patients with localized gastric carcinoids who underwent cancer-directed surgery between 1983 and 2005 were identified from the Surveillance, Epidemiology, and End Results (SEER) registry database.

Results

Tumor size and depth predicted probability of lymph node metastasis. Lymph node metastasis was not seen in intraepithelial (IE) tumors <2 cm. Of tumors <1 cm invading into the lamina propria or submucosa (LP/SM), 3.4% had lymph node metastasis. Excluding IE tumors <2 cm and LP/SM tumors <1 cm, all other subgroups based on size and depth had rates of lymph node metastasis ≥ 8%. Tumor size and depth predicted probability of lymph node sampling. Overall, only 21% of tumors had lymph node sampling. Excluding IE tumors <2 cm and LP/SM tumors <1 cm, only 43% of tumors had lymph node sampling.

Conclusions

Tumor size and depth predict lymph node metastasis for gastric carcinoids. Endoscopic resection may be appropriate for intraepithelial (IE) tumors <2 cm and perhaps tumors <1 cm invading into the lamina propria or submucosa. Lymph node sampling is underused for gastric carcinoids at high risk for lymph node metastasis.

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
Fig. 3

Similar content being viewed by others

References

  1. Kulke MH, Mayer RJ. Carcinoid tumors. N Engl J Med. 1999;340(11):858–68.

    Article  PubMed  CAS  Google Scholar 

  2. Gustafsson BI, Kidd M, Modlin IM. Neuroendocrine tumors of the diffuse neuroendocrine system. Curr Opin Oncol. 2008;20(1):1–12.

    Article  PubMed  Google Scholar 

  3. Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer. 2003;97(4):934–59.

    Article  PubMed  Google Scholar 

  4. Godwin JD 2nd. Carcinoid tumors. An analysis of 2,837 cases. Cancer. 1975;36(2):560–9.

    Article  PubMed  Google Scholar 

  5. Rindi G, Luinetti O, Cornaggia M, Capella C, Solcia E. Three subtypes of gastric argyrophil carcinoid and the gastric neuroendocrine carcinoma: a clinicopathologic study. Gastroenterology. 1993;104(4):994–1006.

    PubMed  CAS  Google Scholar 

  6. Modlin IM, Kidd M, Lye KD. Biology and management of gastric carcinoid tumours: a review. Eur J Surg. 2002;168(12):669–83.

    Article  PubMed  CAS  Google Scholar 

  7. Plöckinger U, Rindi G, Arnold R, et al. Guidelines for the diagnosis and treatment of neuroendocrine gastrointestinal tumours. A consensus statement on behalf of the European Neuroendocrine Tumour Society (ENETS). Neuroendocrinology. 2004;80(6):394–424.

    Google Scholar 

  8. NCCN Neuroendocrine tumors panel. Neuroendocrine tumors. NCCN clinical practice guidelines in oncology version. 2. 2010; Available:http://www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf. Accessed 25 March 2011.

  9. Ramage JK, Davies AH, Ardill J, et al. Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours. Gut. 2005;54 Suppl 4:iv1–16.

    Article  PubMed  Google Scholar 

  10. Chejfec G, Gould VE. Malignant gastric neuroendogrinomas Ultrastructural and biochemical characterization of their secretory activity. Hum Pathol. 1977;8(4):433–440.

    Article  PubMed  CAS  Google Scholar 

  11. Matsui K, Kitagawa M, Miwa A, Kuroda Y, Tsuji M. Small cell carcinoma of the stomach: a clinicopathologic study of 17 cases. Am J Gastroenterol. 1991;86(9):1167–75.

    PubMed  CAS  Google Scholar 

  12. Matsui K, Jin XM, Kitagawa M, Miwa A. Clinicopathologic features of neuroendocrine carcinomas of the stomach: appraisal of small cell and large cell variants. Arch Pathol Lab Med. 1998;122(11):1010–7.

    PubMed  CAS  Google Scholar 

  13. Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG, Morrow M (eds.). Stomach. In: Cancer staging manual, American Joint Committee on Cancer (AJCC) 6th edn. New York: Springer; 2002. p. 99–106.

  14. Kaplan EL, Meier P. Nonparametric estimation form incomplete observations. J Am Stat Assoc. 1958; 53:457–62.

    Article  Google Scholar 

  15. Askanazy M. Zur Pathogenese der Magen-krebse und uber ihren gegentlichen Ursprung aus angeboren epithelialen Keimen in der Magenwand. Dtsch Med Wochenschr. 1923;49:49–51.

    Article  Google Scholar 

  16. Borch K, Ahrén B, Ahlman H, Falkmer S, Granérus G, Grimelius L. Gastric carcinoids: biologic behavior and prognosis after differentiated treatment in relation to type. Ann Surg. 2005;242(1):64–73.

    Article  PubMed  Google Scholar 

  17. Ishikawa K, Etoh T, Shiromizu A, Inomata M, Shiraishi N, Kashima K, et al. A case of sporadic gastric carcinoid tumor treated successfully by laparoscopy-assisted distal gastrectomy. Surg Laparosc Endosc Percutan Tech. 2005;15(6):348–50.

    Article  PubMed  Google Scholar 

  18. de la Fuente SG, McMahon RL, Pickett LC, Pappas TN. Sporadic gastric carcinoid tumor laparoscopically resected: a case report. JSLS. 2004;8(1):85–7.

    PubMed  Google Scholar 

  19. Hyung WJ, Cheong JH, Kim J, Chen J, Choi SH, Noh SH. Application of minimally invasive treatment for early gastric cancer. J Surg Oncol. 2004;85(4):181–5; discussion 186.

    Article  PubMed  Google Scholar 

  20. Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer. 2007;10(1):1–11.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Surgery Service, VA Boston Healthcare System, West Roxbury, MA, USA

    Mandeep S. Saund MD, Riad H. Al Natour MD & Jason S. Gold MD

  2. Brigham and Women’s Hospital, Harvard Medical School, Boston, USA

    Mandeep S. Saund MD, Riad H. Al Natour MD, Qin Huang MD, PhD & Jason S. Gold MD

  3. Pathology Service, VA Boston Healthcare System, West Roxbury, USA

    Qin Huang MD, PhD

  4. Medicine Service, VA Boston Healthcare System, West Roxbury, USA

    Ashish M. Sharma MD & Valia A. Boosalis MD

  5. Boston University School of Medicine, Boston, MA, USA

    Ashish M. Sharma MD & Valia A. Boosalis MD

Authors
  1. Mandeep S. Saund MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Riad H. Al Natour MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ashish M. Sharma MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Qin Huang MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Valia A. Boosalis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jason S. Gold MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jason S. Gold MD.

Additional information

Mandeep S. Saund and Riad H. Al Natour contributed equally to this work

Rights and permissions

Reprints and permissions

About this article

Cite this article

Saund, M.S., Al Natour, R.H., Sharma, A.M. et al. Tumor Size and Depth Predict Rate of Lymph Node Metastasis and Utilization of Lymph Node Sampling in Surgically Managed Gastric Carcinoids. Ann Surg Oncol 18, 2826–2832 (2011). https://doi.org/10.1245/s10434-011-1652-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-011-1652-0

Keywords

Search

Navigation