Servane Gay-Chevallier1, Louis de Mestier2, Julie Perinel3,4, Julien Forestier1, Valérie Hervieu4,5, Philippe Ruszniewski2, Ingrid Millot6, Pierre-Jean Valette4,7, Mathieu Pioche1,4, Catherine Lombard-Bohas1, Fabien Subtil4,8,9, Mustapha Adham3,4, Thomas Walter10,11. 1. Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Gastroentérologie et d'Oncologie Médicale, Lyon, France. 2. Service de Gastroentérologie et Pancréatologie, Hôpital Beaujon, Université de Paris, Clichy, France. 3. Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Chirurgie Digestive, Lyon, France. 4. Université Lyon 1, Université de Lyon, Lyon, France. 5. Hospices Civils de Lyon, Service de Pathologie Multisite, Site EST, Centre de Biologie et de Pathologie Est, Bron, France. 6. Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d'anesthésie-Réanimation, Lyon, France. 7. Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Radiologie, Lyon, France. 8. Hospices Civils de Lyon, Service de Biostatistiques, Lyon, France. 9. CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France. 10. Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Gastroentérologie et d'Oncologie Médicale, Lyon, France, thomas.walter@chu-lyon.fr. 11. Université Lyon 1, Université de Lyon, Lyon, France, thomas.walter@chu-lyon.fr.
Abstract
INTRODUCTION: The characteristics, prognostic factors, and management of duodenal neuroendocrine neoplasms (dNEN) are ill-defined, given their rarity. Whether nonsurgical management might be appropriate for patients with nonmetastatic dNEN and a good prognosis, as is the case for pancreatic NEN (pNEN), is unknown. We aimed to describe the management and prognosis of nonmetastatic dNEN patients. METHODS: All consecutive patients with nonmetastatic dNEN managed between 1981 and 2018 in 2 expert centers were included. Recurrence-free survival (RFS) and factors associated with recurrence were estimated. RESULTS: A total of 145 patients with dNEN were included. Twenty-eight patients with sporadic, nonfunctioning, small (median 7 mm) dNEN underwent endoscopic resection, with a 5-year RFS rate of 89.4%. Local recurrence occurred in 2 patients, who underwent surgery with no new events. The 5-year RFS rate was 87.9% in patients who underwent surgery. Upon univariate analysis, age, size, Ki67 index, and lymph node involvement (LN+) were significantly associated with worse RFS for all dNEN treated (endoscopy/surgery); multivariate analysis found that age, size, and LN+ were associated with worse RFS. CONCLUSION: Selected nonmetastatic dNEN had a favorable outcome, and a less invasive therapeutic strategy appeared more suitable than oncological surgery.
INTRODUCTION: The characteristics, prognostic factors, and management of duodenal neuroendocrine neoplasms (dNEN) are ill-defined, given their rarity. Whether nonsurgical management might be appropriate for patients with nonmetastatic dNEN and a good prognosis, as is the case for pancreatic NEN (pNEN), is unknown. We aimed to describe the management and prognosis of nonmetastatic dNEN patients. METHODS: All consecutive patients with nonmetastatic dNEN managed between 1981 and 2018 in 2 expert centers were included. Recurrence-free survival (RFS) and factors associated with recurrence were estimated. RESULTS: A total of 145 patients with dNEN were included. Twenty-eight patients with sporadic, nonfunctioning, small (median 7 mm) dNEN underwent endoscopic resection, with a 5-year RFS rate of 89.4%. Local recurrence occurred in 2 patients, who underwent surgery with no new events. The 5-year RFS rate was 87.9% in patients who underwent surgery. Upon univariate analysis, age, size, Ki67 index, and lymph node involvement (LN+) were significantly associated with worse RFS for all dNEN treated (endoscopy/surgery); multivariate analysis found that age, size, and LN+ were associated with worse RFS. CONCLUSION: Selected nonmetastatic dNEN had a favorable outcome, and a less invasive therapeutic strategy appeared more suitable than oncological surgery.
Authors: Catherine G Tran; Scott K Sherman; Mohammed O Suraju; Apoorve Nayyar; Henning Gerke; Rami G El Abiad; Chandrikha Chandrasekharan; Po Hien Ear; Thomas M O'Dorisio; Joseph S Dillon; Andrew M Bellizzi; James R Howe Journal: Ann Surg Oncol Date: 2021-09-13 Impact factor: 5.344