Well-Differentiated, Non-Functional, Non-Ampullary Duodenal Neuroendocrine Tumors

Toward Defining Evaluation and Management

Timothy Weatherall, Jason Denbo, John Sharpe, Michael Martin, Thomas O’Brien, Rajib Gupta, Kenneth Groshart, Stephen Behrman, Paxton Dickson

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)844-850
Number of pages7
JournalWorld Journal of Surgery
Volume41
Issue number3
DOIs
StatePublished - Mar 1 2017

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Neuroendocrine Tumors
Neoplasms
Neoplasm Metastasis
Recurrence

All Science Journal Classification (ASJC) codes

  • Surgery

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Well-Differentiated, Non-Functional, Non-Ampullary Duodenal Neuroendocrine Tumors : Toward Defining Evaluation and Management. / Weatherall, Timothy; Denbo, Jason; Sharpe, John; Martin, Michael; O’Brien, Thomas; Gupta, Rajib; Groshart, Kenneth; Behrman, Stephen; Dickson, Paxton.

In: World Journal of Surgery, Vol. 41, No. 3, 01.03.2017, p. 844-850.

Research output: Contribution to journalArticle

Weatherall, T, Denbo, J, Sharpe, J, Martin, M, O’Brien, T, Gupta, R, Groshart, K, Behrman, S & Dickson, P 2017, 'Well-Differentiated, Non-Functional, Non-Ampullary Duodenal Neuroendocrine Tumors: Toward Defining Evaluation and Management', World Journal of Surgery, vol. 41, no. 3, pp. 844-850. https://doi.org/10.1007/s00268-016-3770-0
Weatherall, Timothy ; Denbo, Jason ; Sharpe, John ; Martin, Michael ; O’Brien, Thomas ; Gupta, Rajib ; Groshart, Kenneth ; Behrman, Stephen ; Dickson, Paxton. / Well-Differentiated, Non-Functional, Non-Ampullary Duodenal Neuroendocrine Tumors : Toward Defining Evaluation and Management. In: World Journal of Surgery. 2017 ; Vol. 41, No. 3. pp. 844-850.
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AU - Martin, Michael

AU - O’Brien, Thomas

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AU - Groshart, Kenneth

AU - Behrman, Stephen

AU - Dickson, Paxton

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AB - 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.

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