TY - JOUR
T1 - Duodenal and Ampullary Carcinoid Tumors
T2 - Size Predicts Necessity for Lymphadenectomy
AU - Dogeas, Epameinondas
AU - Cameron, John L.
AU - Wolfgang, Cristopher L.
AU - Hirose, Kenzo
AU - Hruban, Ralph H.
AU - Makary, Martin A.
AU - Pawlik, Timothy A.
AU - Choti, Michael A.
N1 - Publisher Copyright:
© 2017, The Society for Surgery of the Alimentary Tract.
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Background: Unlike other neuroendocrine tumors of the gastrointestinal tract, management of duodenal and periampullary carcinoids remains controversial. We aimed to determine the metastatic potential and optimal choice of therapy for these neoplasms. Methods: A retrospective review of all patients treated at the Johns Hopkins Hospital between 1996 and 2012 was conducted. Clinicopathologic factors associated with lymph nodal involvement and clinical outcomes were evaluated. Results: A total of 101 patients were identified. Eighty (79.2%) tumors arose from the duodenum and 21 (20.8%) from the periampullary area. Thirty-five (34.7%) patients underwent pancreaticoduodenectomy (PD), 12 (11.9%) local resection, 38 (37.6%) endoscopic excision, and 16 (15.8%) patients harbored incidental tumors identified in the specimen after PD for another indication. Lymph node (LN) pathologic evaluation was done in 56 patients, among which 27 (48%) had positive LN. Specifically, LN positivity (LN+) for tumors <1 cm in size was 4.5% (1/22), for tumors 1–2 cm 72% (13/18), and for tumors >2 cm 81% (13/16). Tumor size was the only factor associated with LN+ (p = 0.029). Conclusion: Lymph nodal involvement is common for duodenal and periampullary carcinoid tumors, particularly among those >1 cm in size; therefore, resection with lymphadenectomyfor these larger tumors is recommended.
AB - Background: Unlike other neuroendocrine tumors of the gastrointestinal tract, management of duodenal and periampullary carcinoids remains controversial. We aimed to determine the metastatic potential and optimal choice of therapy for these neoplasms. Methods: A retrospective review of all patients treated at the Johns Hopkins Hospital between 1996 and 2012 was conducted. Clinicopathologic factors associated with lymph nodal involvement and clinical outcomes were evaluated. Results: A total of 101 patients were identified. Eighty (79.2%) tumors arose from the duodenum and 21 (20.8%) from the periampullary area. Thirty-five (34.7%) patients underwent pancreaticoduodenectomy (PD), 12 (11.9%) local resection, 38 (37.6%) endoscopic excision, and 16 (15.8%) patients harbored incidental tumors identified in the specimen after PD for another indication. Lymph node (LN) pathologic evaluation was done in 56 patients, among which 27 (48%) had positive LN. Specifically, LN positivity (LN+) for tumors <1 cm in size was 4.5% (1/22), for tumors 1–2 cm 72% (13/18), and for tumors >2 cm 81% (13/16). Tumor size was the only factor associated with LN+ (p = 0.029). Conclusion: Lymph nodal involvement is common for duodenal and periampullary carcinoid tumors, particularly among those >1 cm in size; therefore, resection with lymphadenectomyfor these larger tumors is recommended.
KW - Carcinoid tumors
KW - Duodenal carcinoid
KW - Lymph nodes
KW - Neuroendocrine tumors
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U2 - 10.1007/s11605-017-3448-4
DO - 10.1007/s11605-017-3448-4
M3 - Article
C2 - 28516311
AN - SCOPUS:85019575052
SN - 1091-255X
VL - 21
SP - 1262
EP - 1269
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 8
ER -