title: Long-term outcome of endoscopic and surgical resection for foregut neuroendocrine tumors.
abstract: OBJECTIVE
  Endoscopic resection (ER) of foregut neuroendocrine tumors (NETs) is increasingly performed instead of surgery. This study aimed to compare the long-term therapeutic outcomes of ER and surgical resection (SR) for foregut NETs.
  
  
  METHODS
  From 2002 to 2012, a total of 49 patients with histologically confirmed foregut NETs were treated by ER (n = 33) and SR (n = 16). The clinicopathological characteristics and therapeutic outcomes were evaluated.
  
  
  RESULTS
  Of the 33 patients who underwent ER [endoscopic mucosal resection (n = 26), endoscopic mucosal dissection (n = 7)], 32 were diagnosed as NET-G1 and NET-G2, and the other as neuroendocrine carcinoma (NEC). Of the 16 patients who underwent SR, 10 were diagnosed as NET-G1, 2 as NET-G2 and 4 as NEC. The median tumor size was significantly smaller in the ER group compared with the SR group (7 mm vs 19 mm, P = 0.001). In almost all patients treated with ER (32/33), NET invasion was limited to the mucosa and submucosa. Non-curative resections were observed in 24.2% of the patients in the ER group (8/33) and 25.0% in the SR group (4/16). No recurrence occurred in NET cases with positive resection margins by ER. However, all cases of non-curative resection with lymphatic invasion (one in the ER group and four in the SR group) developed liver metastasis during the follow-up despite complete resection, and all these five patients has histologically confirmed NECs.
  
  
  CONCLUSIONS
  NET patients treated by ER may have a good prognosis if the tumor size is small and histologically low grade without lymphatic invasion.
authors: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine.
authors: Hee Jae
authors: HJ
authors: Jung
authors: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine.
authors: Su Jin
authors: SJ
authors: Hong
authors: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine.
authors: Jae Pil
authors: JP
authors: Han
authors: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine.
authors: Hyun Su
authors: HS
authors: Kim
authors: Department of Surgery, Soonchunhyang University College of Medicine.
authors: Gui-Ae
authors: GA
authors: Jeong
authors: Department of Surgery, Soonchunhyang University College of Medicine.
authors: Gyu-Seok
authors: GS
authors: Cho
authors: Department of Pathology, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors: Hee Kyoung
authors: HK
authors: Kim
authors: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine.
authors: Bong Min
authors: BM
authors: Ko
authors: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine.
authors: Moon Sung
authors: MS
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D018278:Carcinoma, Neuroendocrine / Q000473:pathology / Q000601:surgery; D004210:Dissection / Q000379:methods*; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D004386:Duodenum / Q000601:surgery; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D008113:Liver Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: endoscopic resection; foregut; long-term outcome; neoplasm metastasis; neuroendocrine tumors; surgery