Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
Aliment Pharmacol Ther. 2020 Jun;51(12):1247-1267. doi: 10.1111/apt.15765. Epub 2020 May 11.
Neuroendocrine tumours (NETs) of the stomach and duodenum are rare, but are increasing in incidence. Optimal management of localised, low-grade gastric and duodenal NETs remains controversial.
To systematically review recent literature that has evaluated the management of localised low-grade gastric and duodenal NETs.
A systematic literature search was conducted. Articles were screened and eligible articles fully assessed. Additional articles were identified through the included articles' reference lists.
Several relevant retrospective case series were identified, but there was considerable heterogeneity between studies and they reported a variety of parameters. Type I gastric NETs had an excellent prognosis and conservative management approaches such as endoscopic surveillance/resection were appropriate in most cases. Many type III gastric NETs were low grade and appeared to have a better prognosis than has previously been appreciated. Endoscopic rather than surgical resection was therefore effective in some patients who had small, low-grade tumours. Duodenal NETs were more heterogenous. Endoscopic resection was generally safe and effective in patients who had small, low-grade, nonfunctional, non-ampullary tumours. However, some patients, especially those with larger or ampullary duodenal NETs, required surgical resection.
Most type I gastric NETs behave indolently and surgical resection is only rarely indicated. Some type III gastric and duodenal NETs have a worse prognosis, but selected patients who have small, localised, nonfunctional, low-grade tumours are adequately and safely treated by endoscopic resection. Due to the complexity of this area, a multidisciplinary approach to management is strongly recommended.
胃和十二指肠的神经内分泌肿瘤（NETs）较为罕见，但发病率正在上升。局限性、低级别胃和十二指肠 NET 的最佳治疗方案仍存在争议。
系统回顾评估局限性低级别胃和十二指肠 NET 治疗方法的最新文献。
进行了系统的文献检索。筛选文章并对合格文章进行全面评估。通过纳入文章的参考文献列表确定了其他文章。
确定了几项相关的回顾性病例系列研究，但研究之间存在很大的异质性，且报道了各种参数。I 型胃 NET 预后极好，在大多数情况下，保守治疗方法如内镜监测/切除是合适的。许多 III 型胃 NET 为低级别，其预后似乎比以前认为的要好。因此，内镜而非手术切除在一些肿瘤较小、低级别患者中是有效的。十二指肠 NET 则更为异质。对于肿瘤较小、低级别、无功能、非壶腹的患者，内镜切除通常是安全有效的。然而，一些患者，特别是那些肿瘤较大或壶腹十二指肠 NET 的患者，需要手术切除。
大多数 I 型胃 NET 生长缓慢，很少需要手术切除。一些 III 型胃和十二指肠 NET 预后较差，但对于肿瘤较小、局限性、无功能、低级别肿瘤的选择患者，内镜切除可充分、安全地进行治疗。由于该领域的复杂性，强烈建议采用多学科方法进行治疗。
