A Multi-institutional Analysis of Duodenal Neuroendocrine Tumors: Tumor Biology Rather than Extent of Resection Dictates Prognosis

Georgios Antonios Margonis, Mario Samaha, Yuhree Kim, Lauren Mc Lendon Postlewait, Pamela Kunz, Shishir Maithel, Thuy Tran, Nickolas Berger, T. Clark Gamblin, Matthew G. Mullen, Todd W. Bauer, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Introduction: Duodenal neuroendocrine tumors (NETs) are rare neoplasms with poorly defined management. We sought to evaluate the outcomes of patients undergoing resection of duodenal NETs. Methods: Using a multi-institutional database, 146 patients who underwent resection for duodenal NETs between 1993 and 2015 were identified. Data on clinicopathologic characteristics and outcomes were collected and analyzed. Results: Local surgical resection (LR) was performed in 57 (39.0 %) patients, while 50 (34.3 %) patients underwent pancreaticoduodenectomy (PD) and 39 (26.7 %) patients an endoscopic resection (ER). Factors associated with worse RFS included advanced tumor grade and metastasis at diagnosis (both P <0.05) but not procedure type (P > 0.05). Among patients who had at least one lymph node examined (n = 85), 50 (58.8 %) had a metastatic lymph node; lymph node metastasis (P = 0.04) and advanced tumor grade (P = 0.04) were more common among patients with tumors >1.5 cm. Median length-of-stay was longer for PD versus LR (P <0.001). PD patients were at increased risk for severe postoperative complications (P = 0.01). Conclusion: Recurrence of duodenal NETs was dependent on tumor biology rather than procedure type. PD was associated with a longer hospital stay and higher risk of perioperative complications. For patients with tumors ≤1.5 cm, LR or ER may be appropriate with PD reserved for larger lesions and those not amenable to a more local approach.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Mar 23 2016

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Neuroendocrine Tumors
Pancreaticoduodenectomy
Neoplasms
Lymph Nodes
Length of Stay
Neoplasm Metastasis
Databases
Recurrence

Keywords

  • Duodenal NETs
  • Prognosis
  • Tumor biology

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

A Multi-institutional Analysis of Duodenal Neuroendocrine Tumors : Tumor Biology Rather than Extent of Resection Dictates Prognosis. / Margonis, Georgios Antonios; Samaha, Mario; Kim, Yuhree; Postlewait, Lauren Mc Lendon; Kunz, Pamela; Maithel, Shishir; Tran, Thuy; Berger, Nickolas; Gamblin, T. Clark; Mullen, Matthew G.; Bauer, Todd W.; Pawlik, Timothy M.

In: Journal of Gastrointestinal Surgery, 23.03.2016, p. 1-8.

Research output: Contribution to journalArticle

Margonis, GA, Samaha, M, Kim, Y, Postlewait, LML, Kunz, P, Maithel, S, Tran, T, Berger, N, Gamblin, TC, Mullen, MG, Bauer, TW & Pawlik, TM 2016, 'A Multi-institutional Analysis of Duodenal Neuroendocrine Tumors: Tumor Biology Rather than Extent of Resection Dictates Prognosis', Journal of Gastrointestinal Surgery, pp. 1-8. https://doi.org/10.1007/s11605-016-3135-x
Margonis, Georgios Antonios ; Samaha, Mario ; Kim, Yuhree ; Postlewait, Lauren Mc Lendon ; Kunz, Pamela ; Maithel, Shishir ; Tran, Thuy ; Berger, Nickolas ; Gamblin, T. Clark ; Mullen, Matthew G. ; Bauer, Todd W. ; Pawlik, Timothy M. / A Multi-institutional Analysis of Duodenal Neuroendocrine Tumors : Tumor Biology Rather than Extent of Resection Dictates Prognosis. In: Journal of Gastrointestinal Surgery. 2016 ; pp. 1-8.
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abstract = "Introduction: Duodenal neuroendocrine tumors (NETs) are rare neoplasms with poorly defined management. We sought to evaluate the outcomes of patients undergoing resection of duodenal NETs. Methods: Using a multi-institutional database, 146 patients who underwent resection for duodenal NETs between 1993 and 2015 were identified. Data on clinicopathologic characteristics and outcomes were collected and analyzed. Results: Local surgical resection (LR) was performed in 57 (39.0 {\%}) patients, while 50 (34.3 {\%}) patients underwent pancreaticoduodenectomy (PD) and 39 (26.7 {\%}) patients an endoscopic resection (ER). Factors associated with worse RFS included advanced tumor grade and metastasis at diagnosis (both P <0.05) but not procedure type (P > 0.05). Among patients who had at least one lymph node examined (n = 85), 50 (58.8 {\%}) had a metastatic lymph node; lymph node metastasis (P = 0.04) and advanced tumor grade (P = 0.04) were more common among patients with tumors >1.5 cm. Median length-of-stay was longer for PD versus LR (P <0.001). PD patients were at increased risk for severe postoperative complications (P = 0.01). Conclusion: Recurrence of duodenal NETs was dependent on tumor biology rather than procedure type. PD was associated with a longer hospital stay and higher risk of perioperative complications. For patients with tumors ≤1.5 cm, LR or ER may be appropriate with PD reserved for larger lesions and those not amenable to a more local approach.",
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T2 - Tumor Biology Rather than Extent of Resection Dictates Prognosis

AU - Margonis, Georgios Antonios

AU - Samaha, Mario

AU - Kim, Yuhree

AU - Postlewait, Lauren Mc Lendon

AU - Kunz, Pamela

AU - Maithel, Shishir

AU - Tran, Thuy

AU - Berger, Nickolas

AU - Gamblin, T. Clark

AU - Mullen, Matthew G.

AU - Bauer, Todd W.

AU - Pawlik, Timothy M.

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N2 - Introduction: Duodenal neuroendocrine tumors (NETs) are rare neoplasms with poorly defined management. We sought to evaluate the outcomes of patients undergoing resection of duodenal NETs. Methods: Using a multi-institutional database, 146 patients who underwent resection for duodenal NETs between 1993 and 2015 were identified. Data on clinicopathologic characteristics and outcomes were collected and analyzed. Results: Local surgical resection (LR) was performed in 57 (39.0 %) patients, while 50 (34.3 %) patients underwent pancreaticoduodenectomy (PD) and 39 (26.7 %) patients an endoscopic resection (ER). Factors associated with worse RFS included advanced tumor grade and metastasis at diagnosis (both P <0.05) but not procedure type (P > 0.05). Among patients who had at least one lymph node examined (n = 85), 50 (58.8 %) had a metastatic lymph node; lymph node metastasis (P = 0.04) and advanced tumor grade (P = 0.04) were more common among patients with tumors >1.5 cm. Median length-of-stay was longer for PD versus LR (P <0.001). PD patients were at increased risk for severe postoperative complications (P = 0.01). Conclusion: Recurrence of duodenal NETs was dependent on tumor biology rather than procedure type. PD was associated with a longer hospital stay and higher risk of perioperative complications. For patients with tumors ≤1.5 cm, LR or ER may be appropriate with PD reserved for larger lesions and those not amenable to a more local approach.

AB - Introduction: Duodenal neuroendocrine tumors (NETs) are rare neoplasms with poorly defined management. We sought to evaluate the outcomes of patients undergoing resection of duodenal NETs. Methods: Using a multi-institutional database, 146 patients who underwent resection for duodenal NETs between 1993 and 2015 were identified. Data on clinicopathologic characteristics and outcomes were collected and analyzed. Results: Local surgical resection (LR) was performed in 57 (39.0 %) patients, while 50 (34.3 %) patients underwent pancreaticoduodenectomy (PD) and 39 (26.7 %) patients an endoscopic resection (ER). Factors associated with worse RFS included advanced tumor grade and metastasis at diagnosis (both P <0.05) but not procedure type (P > 0.05). Among patients who had at least one lymph node examined (n = 85), 50 (58.8 %) had a metastatic lymph node; lymph node metastasis (P = 0.04) and advanced tumor grade (P = 0.04) were more common among patients with tumors >1.5 cm. Median length-of-stay was longer for PD versus LR (P <0.001). PD patients were at increased risk for severe postoperative complications (P = 0.01). Conclusion: Recurrence of duodenal NETs was dependent on tumor biology rather than procedure type. PD was associated with a longer hospital stay and higher risk of perioperative complications. For patients with tumors ≤1.5 cm, LR or ER may be appropriate with PD reserved for larger lesions and those not amenable to a more local approach.

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