Timothy Weatherall1, Jason Denbo1, John Sharpe1, Michael Martin2,3, Thomas O'Brien4, Rajib Gupta5, Kenneth Groshart6, Stephen Behrman1, Paxton Dickson7. 1. Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, 910 Madison Avenue, 3rd Floor, Memphis, TN, 38163, USA. 2. Division of Hematology/Oncology, University of Tennessee Health Science Center, Memphis, TN, USA. 3. West Cancer Center, 7945 Wolf River Blvd, Germantown, TN, 38138, USA. 4. Memphis Pathology Group, 1211 Union Avenue, Suite 300, Memphis, TN, 38104, USA. 5. Department of Pathology, University of Tennessee Health Science Center, 930 Madison Ave, 5th Floor, Memphis, TN, 38163, USA. 6. Pathology Group of the Midsouth, 6019 Walnut Grove Rd, Memphis, TN, 38120, USA. 7. Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, 910 Madison Avenue, 3rd Floor, Memphis, TN, 38163, USA. pdickso1@uthsc.edu.
Abstract
INTRODUCTION: Nonfunctional, non-ampullary duodenal neuroendocrine tumors (dNETs) are rare neoplasms, and specific treatment recommendations are less clear than for other NETs. MATERIALS AND METHODS: We performed a retrospective review of patients (pts) with a diagnosis of dNET, excluding hormonally functional, ampullary, and high-grade tumors. Clinical data were evaluated to identify factors that might impact clinical staging and predictors of metastases. RESULTS: Thirty-six pts were identified. Surgical resection was performed in 28 and endoscopic resection in 8. LNs were included in specimens of 19/28 (68 %) pts who underwent surgical resection (median #LNs 5, range 1-12). Of these 19 pts, 5 (26 %) were found to be LN+. Of LN+ pts, all had tumors ≤2 cm. When compared to LN- pts, LN+ pts were more likely to have muscularis propria (MP) invasion (80 vs. 23 %, p = 0.04). Tumor size, tumor grade, lymphovascular invasion, and multifocality were similar between LN+ and LN- patients. No pt was found to have distant metastases. Heterogeneity in clinical staging modalities and small number of pts evaluated prohibited meaningful analysis of most appropriate preoperative imaging. At a median follow-up of 25 months (range 9-139), no patient developed recurrence or experienced disease-specific death. CONCLUSIONS: Non-functional, non-ampullary dNETs, particularly those with MP invasion, have a propensity to metastasize to regional LNs. However, these neoplasms appear to have a favorable prognosis. Further evaluation of preoperative imaging is required to better determine most appropriate clinical staging. A suggested workup and management strategy for prospective evaluation is proposed.
INTRODUCTION: Nonfunctional, non-ampullary duodenal neuroendocrine tumors (dNETs) are rare neoplasms, and specific treatment recommendations are less clear than for other NETs. MATERIALS AND METHODS: We performed a retrospective review of patients (pts) with a diagnosis of dNET, excluding hormonally functional, ampullary, and high-grade tumors. Clinical data were evaluated to identify factors that might impact clinical staging and predictors of metastases. RESULTS: Thirty-six pts were identified. Surgical resection was performed in 28 and endoscopic resection in 8. LNs were included in specimens of 19/28 (68 %) pts who underwent surgical resection (median #LNs 5, range 1-12). Of these 19 pts, 5 (26 %) were found to be LN+. Of LN+ pts, all had tumors ≤2 cm. When compared to LN- pts, LN+ pts were more likely to have muscularis propria (MP) invasion (80 vs. 23 %, p = 0.04). Tumor size, tumor grade, lymphovascular invasion, and multifocality were similar between LN+ and LN- patients. No pt was found to have distant metastases. Heterogeneity in clinical staging modalities and small number of pts evaluated prohibited meaningful analysis of most appropriate preoperative imaging. At a median follow-up of 25 months (range 9-139), no patient developed recurrence or experienced disease-specific death. CONCLUSIONS: Non-functional, non-ampullary dNETs, particularly those with MP invasion, have a propensity to metastasize to regional LNs. However, these neoplasms appear to have a favorable prognosis. Further evaluation of preoperative imaging is required to better determine most appropriate clinical staging. A suggested workup and management strategy for prospective evaluation is proposed.
Authors: John T Mullen; Huamin Wang; James C Yao; Jeffrey H Lee; Nancy D Perrier; Peter W T Pisters; Jeffrey E Lee; Douglas B Evans Journal: Surgery Date: 2005-12 Impact factor: 3.982
Authors: Matthew H Kulke; Manisha H Shah; Al B Benson; Emily Bergsland; Jordan D Berlin; Lawrence S Blaszkowsky; Lyska Emerson; Paul F Engstrom; Paul Fanta; Thomas Giordano; Whitney S Goldner; Thorvardur R Halfdanarson; Martin J Heslin; Fouad Kandeel; Pamela L Kunz; Boris W Kuvshinoff; Christopher Lieu; Jeffrey F Moley; Gitonga Munene; Venu G Pillarisetty; Leonard Saltz; Julie Ann Sosa; Jonathan R Strosberg; Jean-Nicolas Vauthey; Christopher Wolfgang; James C Yao; Jennifer Burns; Deborah Freedman-Cass Journal: J Natl Compr Canc Netw Date: 2015-01 Impact factor: 11.908
Authors: Brian R Untch; Keisha P Bonner; Kevin K Roggin; Diane Reidy-Lagunes; David S Klimstra; Mark A Schattner; Yuman Fong; Peter J Allen; Michael I D'Angelica; Ronald P DeMatteo; William R Jarnagin; T Peter Kingham; Laura H Tang Journal: J Gastrointest Surg Date: 2014-01-22 Impact factor: 3.452
Authors: James C Yao; Manal Hassan; Alexandria Phan; Cecile Dagohoy; Colleen Leary; Jeannette E Mares; Eddie K Abdalla; Jason B Fleming; Jean-Nicolas Vauthey; Asif Rashid; Douglas B Evans Journal: J Clin Oncol Date: 2008-06-20 Impact factor: 44.544
Authors: N J Zyromski; M L Kendrick; D M Nagorney; C S Grant; J H Donohue; M B Farnell; G B Thompson; D R Farley; M G Sarr Journal: J Gastrointest Surg Date: 2001 Nov-Dec Impact factor: 3.452
Authors: Bobby V M Dasari; Sarah Al-Shakhshir; Timothy M Pawlik; Tahir Shah; Ravi Marudanayagam; Robert P Sutcliffe; Darius F Mirza; Paolo Muiesan; Keith J Roberts; John Isaac Journal: J Gastrointest Surg Date: 2018-06-04 Impact factor: 3.452