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.
Similar content being viewed by others
References
Zani A, et al, Incidentally Detected Meckel Diverticulum: To Resect or Not to Resect? Annals of Surgery, 2008, 247. 276–281
Thirunavukarasu P, et al Meckel’s Diverticulum- A High-Risk Region for Malignancy in the Ileum, Annals of Surgery, 2011, 253. 223–230
Lorenzen A, et al, Neuroendocrine Tumors Arising in Meckel’s Diverticula: Frequency of Advanced Disease Warrants Aggressive Management, J Gastrointest Surg, 2013, 17. 1084–1091
Lequet J, Menahem B, Mulliri A. Meckel’s diverticulum in the adult, J Visc Surg. 2017, 154(4), 253–259
National Comprehensive Cancer Network. Neuroendocrine tumor (Version 2.2018). https://www.nccn.org/professionals/physician_gls/PDF/neuroendocrine.pdf. Accessed May 4, 2018
Motz B J, et al, Optimal Lymphadenectomy in Small Bowel Neuroendocrine Tumors: Analysis of the NCDB, J Gastrointest Surg, 2018, 22: 117–123
Anderson D. Carcinoid tumor in Meckel’s diverticulum: laparoscopic treatment and review of the literature, JAOA, 2000, 100, 432–434
Poncet G, et al, Neuroendocrine Tumors of Meckel’s Diverticulum: Lessons from a Single Institution Study of Eight Cases, J Gastrointest Surg, 2010, 15. 101–109
Boffa D, et al, Using the National Cancer Database for Outcomes Research: A Review, JAMA Oncology, 2017, E1-E6
Shi C, Adsay V, Washington MK. Protocol for the Examination of Specimens From Patients with Neuroendocrine Tumor of the Jejunum and Ileum, 8th Edition AJCC Staging Manual, June 2017
Chan JA, Kulke MH, Medical Management of Pancreatic Neuroendocrine Tumors: Current and Future Therapy, Surg Oncol Clin N Am, 2016, 25, 423–437
Chen L, Song Y, Zhang Y, Chen J, Exploration of the Exact Prognostic Significance of Lymphatic Metastasis in Jejunoileal Neuroendocrine Tumors, Ann Surg Oncol, 2018, 25, 2067–2074
Author information
Authors and Affiliations
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
Corresponding author
Ethics declarations
Sources of Support
None.
Disclosure of Funding
None.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Dogeas, E., Magallanes, M., Porembka, M.R. et al. Neuroendocrine Tumors in Meckel’s Diverticulum: Recommendation for Lymphadenectomy Regardless of Tumor Size Based on the NCDB Experience. J Gastrointest Surg 23, 679–685 (2019). https://doi.org/10.1007/s11605-018-04096-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-018-04096-7