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A Multi-institutional Analysis of Duodenal Neuroendocrine Tumors: Tumor Biology Rather than Extent of Resection Dictates Prognosis
Authors:Georgios?Antonios?Margonis,Mario?Samaha,Yuhree?Kim,Lauren?McLendon?Postlewait,Pamela?Kunz,Shishir?Maithel,Thuy?Tran,Nickolas?Berger,T.?Clark?Gamblin,Matthew?G.?Mullen,Todd?W.?Bauer,Timothy?M.?Pawlik  author-information"  >  author-information__contact u-icon-before"  >  mailto:tpawlik@jhmi.edu"   title="  tpawlik@jhmi.edu"   itemprop="  email"   data-track="  click"   data-track-action="  Email author"   data-track-label="  "  >Email author
Affiliation:1.Department of Surgery,The Johns Hopkins University School of Medicine,Baltimore,USA;2.Department of Surgery,Emory University,Atlanta,USA;3.Department of Surgery,Stanford University School of Medicine,Stanford,USA;4.Department of Surgery,Medical College of Wisconsin,Milwaukee,USA;5.Department of Surgery,University of Virginia,Charlottesville,USA
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?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?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.
Keywords:
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