Duodenal and Ampullary Carcinoid Tumors

Size Predicts Necessity for Lymphadenectomy

Epameinondas Dogeas, John L. Cameron, Cristopher L. Wolfgang, Kenzo Hirose, Ralph H. Hruban, Martin A. Makary, Timothy A. Pawlik, Michael A. Choti

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Unlike other neuroendocrine tumors of the gastrointestinal tract, management of duodenal and periampullary carcinoids remains controversial. We aimed to determine the metastatic potential and optimal choice of therapy for these neoplasms. Methods: A retrospective review of all patients treated at the Johns Hopkins Hospital between 1996 and 2012 was conducted. Clinicopathologic factors associated with lymph nodal involvement and clinical outcomes were evaluated. Results: A total of 101 patients were identified. Eighty (79.2%) tumors arose from the duodenum and 21 (20.8%) from the periampullary area. Thirty-five (34.7%) patients underwent pancreaticoduodenectomy (PD), 12 (11.9%) local resection, 38 (37.6%) endoscopic excision, and 16 (15.8%) patients harbored incidental tumors identified in the specimen after PD for another indication. Lymph node (LN) pathologic evaluation was done in 56 patients, among which 27 (48%) had positive LN. Specifically, LN positivity (LN+) for tumors <1 cm in size was 4.5% (1/22), for tumors 1–2 cm 72% (13/18), and for tumors >2 cm 81% (13/16). Tumor size was the only factor associated with LN+ (p = 0.029). Conclusion: Lymph nodal involvement is common for duodenal and periampullary carcinoid tumors, particularly among those >1 cm in size; therefore, resection with lymphadenectomyfor these larger tumors is recommended.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - May 17 2017

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Carcinoid Tumor
Lymph Node Excision
Lymph Nodes
Neoplasms
Pancreaticoduodenectomy
Lymph
Neuroendocrine Tumors
Duodenum
Gastrointestinal Tract

Keywords

  • Carcinoid tumors
  • Duodenal carcinoid
  • Lymph nodes
  • Neuroendocrine tumors

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Duodenal and Ampullary Carcinoid Tumors : Size Predicts Necessity for Lymphadenectomy. / Dogeas, Epameinondas; Cameron, John L.; Wolfgang, Cristopher L.; Hirose, Kenzo; Hruban, Ralph H.; Makary, Martin A.; Pawlik, Timothy A.; Choti, Michael A.

In: Journal of Gastrointestinal Surgery, 17.05.2017, p. 1-8.

Research output: Contribution to journalArticle

Dogeas, Epameinondas ; Cameron, John L. ; Wolfgang, Cristopher L. ; Hirose, Kenzo ; Hruban, Ralph H. ; Makary, Martin A. ; Pawlik, Timothy A. ; Choti, Michael A. / Duodenal and Ampullary Carcinoid Tumors : Size Predicts Necessity for Lymphadenectomy. In: Journal of Gastrointestinal Surgery. 2017 ; pp. 1-8.
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abstract = "Background: Unlike other neuroendocrine tumors of the gastrointestinal tract, management of duodenal and periampullary carcinoids remains controversial. We aimed to determine the metastatic potential and optimal choice of therapy for these neoplasms. Methods: A retrospective review of all patients treated at the Johns Hopkins Hospital between 1996 and 2012 was conducted. Clinicopathologic factors associated with lymph nodal involvement and clinical outcomes were evaluated. Results: A total of 101 patients were identified. Eighty (79.2{\%}) tumors arose from the duodenum and 21 (20.8{\%}) from the periampullary area. Thirty-five (34.7{\%}) patients underwent pancreaticoduodenectomy (PD), 12 (11.9{\%}) local resection, 38 (37.6{\%}) endoscopic excision, and 16 (15.8{\%}) patients harbored incidental tumors identified in the specimen after PD for another indication. Lymph node (LN) pathologic evaluation was done in 56 patients, among which 27 (48{\%}) had positive LN. Specifically, LN positivity (LN+) for tumors <1 cm in size was 4.5{\%} (1/22), for tumors 1–2 cm 72{\%} (13/18), and for tumors >2 cm 81{\%} (13/16). Tumor size was the only factor associated with LN+ (p = 0.029). Conclusion: Lymph nodal involvement is common for duodenal and periampullary carcinoid tumors, particularly among those >1 cm in size; therefore, resection with lymphadenectomyfor these larger tumors is recommended.",
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AU - Hruban, Ralph H.

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AB - Background: Unlike other neuroendocrine tumors of the gastrointestinal tract, management of duodenal and periampullary carcinoids remains controversial. We aimed to determine the metastatic potential and optimal choice of therapy for these neoplasms. Methods: A retrospective review of all patients treated at the Johns Hopkins Hospital between 1996 and 2012 was conducted. Clinicopathologic factors associated with lymph nodal involvement and clinical outcomes were evaluated. Results: A total of 101 patients were identified. Eighty (79.2%) tumors arose from the duodenum and 21 (20.8%) from the periampullary area. Thirty-five (34.7%) patients underwent pancreaticoduodenectomy (PD), 12 (11.9%) local resection, 38 (37.6%) endoscopic excision, and 16 (15.8%) patients harbored incidental tumors identified in the specimen after PD for another indication. Lymph node (LN) pathologic evaluation was done in 56 patients, among which 27 (48%) had positive LN. Specifically, LN positivity (LN+) for tumors <1 cm in size was 4.5% (1/22), for tumors 1–2 cm 72% (13/18), and for tumors >2 cm 81% (13/16). Tumor size was the only factor associated with LN+ (p = 0.029). Conclusion: Lymph nodal involvement is common for duodenal and periampullary carcinoid tumors, particularly among those >1 cm in size; therefore, resection with lymphadenectomyfor these larger tumors is recommended.

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