Introduction: Duodenal neuro endocrine tumors (d-NETs) comprise about 2% of all NETs. Treatment of d-NETs involves resection of the tumour either by endoscopic or surgical resection. Local resection of the lesion is usually a safer option compared to a more radical pancreaticoduodenectomy. However, inadequate clearance by local resection might result in recurrent disease and reduce the overall survival. There is no current available evidence regarding the extent of resection.
Methods: The current systematic review compares the differences in outcomes of endoscopic resection (ER), local resection (LR) and pancreaticoduodenectomy (PD) in the management of dNETs. Searches were performed on MEDLINE, PubMed, Embase and Cochrane databases using MeSH keyword combinations: duodenal, AND, neuroendocrine tumours. All relevant articles published up to 2016 were included. Post-operative morbidity, R0 resection status and recurrence rates were the outcomes assessed.
Results: Eight non-randomised retrospective studies with 335 participants were included (LR=122; PD=118; ER=64). PD is associated with higher morbidity compared LR (27/64 vs 10/74; P=0.002) but is associated with better R0 resection status (3/97 vs 15/97; P=0.007) and lesser recurrence rates (3/51 vs 6/46; P=0.21). ER is associated with a higher resection margin positive status when compared to LR group (22/51 vs 14/91; P=0.0002).
Conclusions: Radical surgical resection in the form of PD is associated with better long-term outcomes but with higher post-operative morbidity in patients with dNETs. Larger multi-institutional studies are required to help obtain data to gain consensus based on well-matched cohorts.
04 Dec 2017
UK and Ireland Neuroendocrine Tumour Society