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Duodenal carcinoid tumors: how aggressive should we be?
N J Zyromski1, M L Kendrick, D M Nagorney
1Gastroenterology Research Unit and Department of Surgery, Mayo Clinic, Rochester, Minn. 55905, USA.
Summary
Duodenal carcinoid tumors smaller than 2 cm can be treated with local excision. Larger tumors may require more aggressive treatment, but their outcomes are uncertain.
Area of Science:
- Gastroenterology
- Surgical Oncology
Background:
- Duodenal carcinoid tumors are rare, and their clinical behavior is not well-defined.
- Understanding their behavior is crucial for determining appropriate surgical resection strategies.
Purpose of the Study:
- To evaluate the clinical behavior and treatment outcomes of primary duodenal carcinoid tumors.
- To establish guidelines for the management of duodenal carcinoid tumors based on size and location.
Main Methods:
- Retrospective review of 27 patients with primary duodenal carcinoid tumors diagnosed between 1976 and 1999.
- Analysis of treatment modalities including endoscopic excision, transduodenal excision, and pancreaticoduodenectomy.
- Correlation of tumor size and location with patient outcomes, including disease recurrence.
Main Results:
- 18 of 19 patients with tumors < 2 cm remained disease-free after local excision.
- All four patients with tumors ≥ 2 cm who underwent resection for cure experienced recurrence.
- Periampullary carcinoid tumors exhibited unpredictable behavior.
Conclusions:
- Duodenal carcinoid tumors < 2 cm are amenable to local excision.
- Open transduodenal excision is recommended for tumors between 1 and 2 cm to ensure complete resection.
- Management of duodenal carcinoid tumors ≥ 2 cm requires further investigation; ampullary/periampullary tumors warrant separate consideration.
