Service de Chirurgie Digestive, Endocrinienne et Générale, CHU de Limoges, Avenue Martin Luther King, Limoges Cedex.
Gastro-entérologie, hépatologie et oncologie médicale, Hôpital Édouard-Herriot, Hospices civils de Lyon, Lyon.
Int J Surg. 2024 Jul 1;110(7):4259-4265. doi: 10.1097/JS9.0000000000001382.
Duodenal neuroendocrine tumours (D-NETs) have a low incidence; however, their diagnosis has been increasing. Features such as tumour location, size, type, histological grade, and stage were used to adapt the treatment to either endoscopic (ER) or surgical (SR) resections. There is no consensus regarding the definitive treatment. The authors' study aimed to describe the management of non-metastatic, well-differentiated D-NETs in France and its impact on patient survival.
A registry-based multicenter study using prospectively collected data between 2000 and 2019, including all patients managed for non-metastatic G1 and G2 D-NETs, was conducted in the GTE group.
A total of 153 patients were included. Fifty-eight benefited from an ER, and 95 had an SR. No difference in recurrence-free survival (RFS) was observed regardless of treatment type. There was no significant difference between the two groups (ER vs. SR) in terms of location, size, grade, or lymphadenopathy, regardless of the type of incomplete resection performed or regarding the pre-therapeutic assessment of lymph node invasion in imaging. The surgery allowed for significantly more complete resection (patients with R1 resection in the SR group: 9 vs. 14 in the ER group, P <0.001). Among the 51 patients with positive lymph node dissection after SR, tumour size was less than or equal to 1 cm in 25 cases. Surgical complications were more numerous ( P =0.001). In the sub-group analysis of G1-G2 D-NETs between 11 and 19 mm, there was no significant difference in grade ( P =0.977) and location ( P =0.617) between the two groups (ER vs. SR). No significant difference was found in both morphological and functional imaging, focusing on the pre-therapeutic assessment of lymph node invasion ( P =0.387).
Regardless of the resection type (ER or SR) of G1-G2 non-metastatic D-NETs, as well as the type of management of incomplete resection, which was greater in the ER group, long-term survival results were similar between ER and SR. Organ preservation seems to be the best choice owing to the slow evolution of these tumours.
十二指肠神经内分泌肿瘤（D-NETs）的发病率较低，但诊断率却在不断上升。肿瘤位置、大小、类型、组织学分级和分期等特征被用于指导内镜（ER）或外科（SR）切除治疗。目前，对于 D-NETs 的治疗方法尚无定论。本研究旨在描述法国非转移性、分化良好的 D-NETs 的治疗方法，并评估其对患者生存的影响。
本研究采用基于注册的多中心研究，于 2000 年至 2019 年期间前瞻性收集数据，纳入所有非转移性 G1 和 G2 D-NETs 患者，这些患者接受了 GTE 组的治疗。
共纳入 153 例患者。58 例患者接受 ER 治疗，95 例患者接受 SR 治疗。无论治疗类型如何，两组患者的无复发生存率（RFS）均无差异。两组患者（ER 与 SR）的位置、大小、分级或淋巴结肿大均无显著差异，且无论行何种不完全切除术，或影像学检查对淋巴结侵犯的术前评估如何，结果均如此。手术可实现更完全的肿瘤切除（SR 组行 R1 切除术的患者：9 例 vs. ER 组的 14 例，P<0.001）。在 95 例行 SR 治疗的患者中，51 例患者行淋巴结清扫术，其中 25 例患者的肿瘤直径≤1cm。SR 组的手术并发症更多（P=0.001）。在 11-19mm 的 G1-G2 D-NETs 亚组分析中，两组患者的分级（P=0.977）和位置（P=0.617）无显著差异（ER 与 SR）。两种形态学和功能影像学检查均无显著差异，重点是术前评估淋巴结侵犯（P=0.387）。
无论 G1-G2 非转移性 D-NETs 采用哪种切除术（ER 或 SR），以及哪种不完全切除治疗方法（ER 组的治疗方法更多），ER 与 SR 的长期生存结果相似。由于这些肿瘤的生长缓慢，因此器官保留似乎是最佳选择。
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