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Published on: December 20, 2024
Endoscopic versus surgical resection of duodenal neuroendocrine neoplasms between 10 and 20 mm: A multi-centered
Felix Hers1, Heinz-Josef Klümpen2, Koen M A Dreijerink3
1Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Center for Endocrine and Neuroendocrine Tumours (ACcENT), Cancer Center Amsterdam, ENETS Center of Excellence, Amsterdam, The Netherlands; Amsterdam Cancer Center, Amsterdam, The Netherlands.
Introduction:
Recommendations for resection technique of duodenal neuroendocrine neoplasms (D-NEN) with a size between 10 and 20 mm are lacking. The primary aim was to compare overall survival (OS) and progression-free survival (PFS) after endoscopic resection (ER) with surgical resection (SR). The secondary aim was to assess the incidence and clinical variables correlated with OS.
Methods:
Data of patients with D-NENs between 2008 and 2018 were extracted from the Netherlands Cancer Registry and the Dutch Nationwide Pathology Databank.
Results:
A total of 259 patients were identified, of which 138 were included: 98 (68 %) underwent ER and 44 patients (32 %) underwent SR. Of these, 38 patients had D-NENs sized between 10 and 20 mm. ER Patients were more frequently male and had a lower T-stage and tumour size than SR patients (all P < 0.05). Positive resection margins were observed more frequently after ER compared to SR (71 % vs 15 %, P < 0.005). No patients with tumours between 10 and 20 mm died after ER or SR (median follow-up 71.8 vs. 52.0 months). PFS rates were not significantly different after ER compared to SR (P = 0.672). Recurrence rates were 13 % for ER and 7 % for SR (P = 0.604).
Conclusion:
Between 2008 and 2018, the incidence increased from 0.06 to 0.11 per 100,000 patients per year. OS after ER or SR did not differ for D-NEN between 10 and 20 mm. Recurrence and PFS rates were not significantly different. These results suggest that D-NENs sized between 10 and 20 mm could potentially be treated first with ER. Future studies are needed to confirm this hypothesis.
