Long-term outcomes of endoscopic resection for well-differentiated nonampullary duodenal neuroendocrine tumors

Yun Wang; Zhong Ren; Yue-Hong Shen; Xi-Guo Fang; Quan-Lin Li; Yun-Shi Zhong; Yi-Qun Zhang; Wei-Feng Chen; Ping-Hong Zhou; Sheng-Li Lin

doi:10.1016/j.gie.2024.02.017

Long-term outcomes of endoscopic resection for well-differentiated nonampullary duodenal neuroendocrine tumors

Gastrointest Endosc. 2024 Feb 29:S0016-5107(24)00130-5. doi: 10.1016/j.gie.2024.02.017. Online ahead of print.

Authors

Affiliations

¹ Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, China.
² Nursing department, Zhongshan Hospital, Fudan University, Shanghai, China.
³ Gastroenterology department, People's Hospital of Yi'an District, Tonglin, Anhui, China.
⁴ Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, China. Electronic address: zhou.pinghong@zs-hospital.sh.cn.
⁵ Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, China. Electronic address: lin.shengli@zs-hospital.sh.cn.

PMID: 38431107
DOI: 10.1016/j.gie.2024.02.017

Abstract

Background & aims: Nonampullary duodenal neuroendocrine tumors (NAD-NETs) are rare with limited evidence regarding endoscopic treatment. The study aimed to investigate the efficacy and safety of endoscopic resection of well-differentiated NAD-NETs and evaluate long-term outcomes, including local recurrence and metastasis.

Methods: A total of 78 patients with NAD-NETs who underwent endoscopic resection between January 2011 and August 2022 were included. The clinicopathologic characteristics and treatment outcomes were collected and analyzed.

Results: En bloc resection was achieved for 74 of the tumors (94.9%) and R0 resection was obtained in 68 of the tumors (87.2%). Univariate analysis identified tumors in the second part of the duodenum, tumor size ≥ 10 mm and muscularis propria invasion as risk factors for non-curative resection. Two patients with R1 resection (vertical margin involvement) and two patients with lymphovascular invasion underwent additional surgery. Four patients experienced adverse events (5.1%), including two cases of delayed bleeding and two cases of perforation, all successfully managed conservatively. During a median follow-up period of 62.6 months, recurrence and lymph node metastasis were only detected in one patient with R1 resection 3 months after the original procedure.

Conclusion: Endoscopic resection is safe and effective and provides a favorable long-term outcome for patients with well-differentiated NAD-NETs without regional lymph node or distant metastasis.

Keywords: duodenum; endoscopic resection; neuroendocrine tumor.