Pathologic grade and tumor size are associated with recurrence-free survival in patients with duodenal neuroendocrine tumors.
BACKGROUND
Duodenal neuroendocrine tumors are rare and few studies exist to guide surgical management. This study identifies factors associated with recurrence after resection.


METHODS
A retrospective, single institution review was performed between 1983 and 2011 on patients with a pathologic diagnosis of duodenal neuroendocrine tumor. Tumor grade was assigned based on WHO 2010 criteria (Ki-67 and mitotic rate).


RESULTS
Seventy-five patients were identified that underwent curative resection. This included 12 patients with endoscopic mucosal resection, 34 that had local resection, and 29 that underwent pancreaticoduodenectomy. Two-year and 5-year recurrence-free survival was 84 and 81%, respectively. There were 11 tumor recurrences (either local or distant), and four patients died of their disease (3/4 had high-grade lesions) with an overall median follow-up of 27 months. On univariate analysis, tumor size and tumor grade were identified as being associated with recurrence, but not intervention type, lymph node metastases, ampullary location, or margin status.


CONCLUSIONS
Tumor grade and size are associated with recurrence-free survival in duodenal neuroendocrine tumors. When feasible, a less aggressive surgical approach to treat low-grade and low-stage duodenal NETs should be considered.
Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA, untchb@mskcc.org.
Brian R
BR
Untch
Keisha P
KP
Bonner
Kevin K
KK
Roggin
Diane
D
Reidy-Lagunes
David S
DS
Klimstra
Mark A
MA
Schattner
Yuman
Y
Fong
Peter J
PJ
Allen
Michael I
MI
D'Angelica
Ronald P
RP
DeMatteo
William R
WR
Jarnagin
T Peter
TP
Kingham
Laura H
LH
Tang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D004379:Duodenal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004384:Duodenoscopy; D004386:Duodenum / Q000601:surgery; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D047368:Tumor Burden