Nakao Eisuke, Namikawa Ken, Hirasawa Toshiaki, Nakano Kaoru, Tokai Yoshitaka, Yoshimizu Shoichi, Horiuchi Yusuke, Ishiyama Akiyoshi, Yoshio Toshiyuki, Nunobe Souya, Fujisaki Junko
Department of Gastroenterology Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan.
Department of Pathology Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan.
JGH Open. 2022 Feb 17;6(3):189-195. doi: 10.1002/jgh3.12718. eCollection 2022 Mar.
The risk factors for lymph node metastasis (LNM) of duodenal neuroendocrine tumors (DNETs) are not well identified, and a definitive standard of treatment for DNETs has not been established. In this study, we aimed to identify the risk factors for LNM and establish the indication of local resection for DNETs.
We retrospectively reviewed 55 patients with 60 non-ampullary and nonfunctional DNETs. We evaluated the risk factors for LNM and compared the outcomes between endoscopic resection (ER) for DNETs <5 mm and laparoscopy and endoscopy cooperative surgery (LECS) for DNETs ≥5 mm.
LNM was present in four (8.7%) patients. Univariate analysis revealed that tumor size ≥10 mm, positive lymphovascular invasion (LVI), and 0-Is morphology were significantly associated with LNM ( = 0.008, = 0.037, and = 0.045, respectively). ER and LECS were performed for 18 and 11 DNETs, respectively. All lesions treated with ER or LECS were confined to the submucosal layer. The median tumor size was 3 mm in ER and 6 mm in LECS. Although there was no significant difference in the R0 (no residual tumor) resection rate, R0 resection was completely achieved in the LECS. No significant differences were observed in terms of complication rates. No recurrence was observed in any of the groups.
Tumor size ≥10 mm, positive LVI, and 0-Is morphology were significant risk factors for LNM. We demonstrated that ER is feasible and could be safely applied for DNETs <5 mm, and LECS could be applied for DNETs 5-10 mm in size.
十二指肠神经内分泌肿瘤（DNETs）淋巴结转移（LNM）的危险因素尚未明确，且DNETs的明确治疗标准也未确立。在本研究中，我们旨在确定LNM的危险因素，并确立DNETs局部切除的指征。
我们回顾性分析了55例患者的60个非壶腹性、无功能的DNETs。我们评估了LNM的危险因素，并比较了直径<5mm的DNETs行内镜切除（ER）与直径≥5mm的DNETs行腹腔镜与内镜联合手术（LECS）的疗效。
4例（8.7%）患者存在LNM。单因素分析显示，肿瘤大小≥10mm、淋巴管侵犯（LVI）阳性和0-Is形态与LNM显著相关（分别为P=0.008、P=0.037和P=0.045）。分别对18个和11个DNETs进行了ER和LECS。所有接受ER或LECS治疗的病变均局限于黏膜下层。ER组肿瘤大小中位数为3mm，LECS组为6mm。虽然R0（无残留肿瘤）切除率无显著差异，但LECS组完全实现了R0切除。并发症发生率方面未观察到显著差异。所有组均未观察到复发。
肿瘤大小≥10mm、LVI阳性和0-Is形态是LNM的重要危险因素。我们证明，ER是可行的，可安全应用于直径<5mm的DNETs，LECS可应用于直径5-10mm的DNETs。
