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Is local excision sufficient in selected grade 1 or 2 type III gastric neuroendocrine neoplasms?

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Abstract

Purpose

Type III gastric neuroendocrine neoplasms (g-NENs) have historically been regarded as aggressive tumours, hence current guidelines advocate radical surgery with lymph node dissection. Data on the roles of endoscopic or less extensive surgical resections are more limited. The aim of our study is to evaluate the clinicopathological features and long-term outcomes of patients undergoing endoscopic or limited surgical resection for localised grade 1 or 2 type III g-NENs when compared to radical surgery.

Methods

Retrospective analysis of all patients diagnosed with a localised grade 1 or 2 type III g-NENs across six tertiary NEN centers between 2006 and 2019.

Results

Forty-five patients were diagnosed with a potentially resectable grade 1 or 2 type III g-NEN of whom 36 underwent either endoscopic or surgical resection. No statistically significant differences were found between the three resection groups in terms of patient age, tumour location, grade or size. Only tumour size was found to be significantly associated with poor clinical outcome (p = 0.012) and ROC curve analysis identified tumour size >10 mm as a negative predictor (AUC:0.8030, p = 0.0021). Tumours >10 mm were also more likely to be associated with lymph node metastases on imaging and histology (p = 0.039 and p = 0.026 respectively).

Conclusions

Localised grade 1 or 2 type III g-NENs had a good prognosis in this series. Tumour size >10 mm was the most significant prognostic factor affecting patient outcome. Endoscopic resection or limited surgical resection is feasible and safe in small type III g-NENs which demonstrate favourable grade 1/2, well differentiated histology.

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Data availability

Data available on request from the authors

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Author contributions

D.M.P. and C.T. conceived and designed the study. K.E., L.K., M.T., A.V., K.O., M.S.K., R.S. identified patients and extracted clinical data. M.S.K., R.S., D.M., S.G.G., G.K., N.H. oversaw project at their centre. K.E. performed the analysis and with D.M.P. wrote the first draft of the paper. K.E., D.M.P. and C.T. revised the paper for important intellectual content. All authors have approved the final version of this paper. The guarantor of this article is Dr. C.T.

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Author notes

  1. These authors contributed equally: D. Mark Pritchard, Christos Toumpanakis

Authors and Affiliations

  1. Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool and Liverpool ENETS Centre of Excellence, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK

    Klaire Exarchou & D. Mark Pritchard

  2. Department of Upper Gastrointestinal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK

    Klaire Exarchou & Nathan Howes

  3. Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free Hospital, London, UK

    Lukasz Kamieniarz, Dalvinder Mandair & Christos Toumpanakis

  4. 1st Department of Propaedeutic Internal Medicine, Endocrine Oncology Unit, ENETS Centre of Excellence, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Marina Tsoli & Gregory Kaltsas

  5. South Wales NET Service, Department of Gastroenterology, University Hospital of Wales, Cardiff, UK

    Alexandra Victor & Mohid S. Khan

  6. Neuroendocrine Tumor Unit, ENETS Center of Excellence, Endocrinology & Metabolism Department, Division of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Kira Oleinikov & Simona Grozinsky-Glasberg

  7. Department of Gastroenterology, Institute of Liver studies, Kings College Hospital, ENETS Centre of Excellence, London, UK

    Raj Srirajaskanthan

Authors
  1. Klaire Exarchou
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Corresponding author

Correspondence to Christos Toumpanakis.

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Conflict of interest

D.M.P. has acted as a consultant for Ipsen, Advanced Accelerator Applications and Laboratoire Mayoly Spindler and has received research funding from Trio Medicines UK. S.G.G. has received research support from Novartis and Ipsen and honoraria from Novartis, Ipsen, Pfizer, and Lexicon. R.S. has received research support form Novartis and Ipsen. None of the other authors have any competing interests to declare.

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No ethical approval was required for this retrospective study. Each individual institution sought and was granted local approval by their respective Research and Audit Departments.

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Exarchou, K., Kamieniarz, L., Tsoli, M. et al. Is local excision sufficient in selected grade 1 or 2 type III gastric neuroendocrine neoplasms?. Endocrine 74, 421–429 (2021). https://doi.org/10.1007/s12020-021-02775-1

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