Pathologic grade and tumor size are associated with recurrence-free survival in patients with duodenal neuroendocrine tumors.
BACKGROUND: Duodenal neuroendocrine tumors are rare and few studies exist to guide surgical management. This study identifies factors associated with recurrence after resection. METHODS: A retrospective, single institution review was performed between 1983 and 2011 on patients with a pathologic diagnosis of duodenal neuroendocrine tumor. Tumor grade was assigned based on WHO 2010 criteria (Ki-67 and mitotic rate). RESULTS: Seventy-five patients were identified that underwent curative resection. This included 12 patients with endoscopic mucosal resection, 34 that had local resection, and 29 that underwent pancreaticoduodenectomy. Two-year and 5-year recurrence-free survival was 84 and 81%, respectively. There were 11 tumor recurrences (either local or distant), and four patients died of their disease (3/4 had high-grade lesions) with an overall median follow-up of 27 months. On univariate analysis, tumor size and tumor grade were identified as being associated with recurrence, but not intervention type, lymph node metastases, ampullary location, or margin status. CONCLUSIONS: Tumor grade and size are associated with recurrence-free survival in duodenal neuroendocrine tumors. When feasible, a less aggressive surgical approach to treat low-grade and low-stage duodenal NETs should be considered.
Untch, BR; Bonner, KP; Roggin, KK; Reidy-Lagunes, D; Klimstra, DS; Schattner, MA; Fong, Y; Allen, PJ; D'Angelica, MI; DeMatteo, RP; Jarnagin, WR; Kingham, TP; Tang, LH
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