Neuroendocrine Tumors in Meckel’s Diverticulum: Recommendation for Lymphadenectomy Regardless of Tumor Size Based on the NCDB Experience

Epameinondas Dogeas, Maximiliano Magallanes, Matthew R. Porembka, Sam C. Wang, Adam C. Yopp, Patricio M. Polanco, John C. Mansour, Michael A Choti, Herbert J. Zeh, Mathew M. Augustine

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Abstract

Background: Meckel’s diverticulum (MD) is an anomaly of the small intestine from which malignancy may arise. Among MD neoplasms, neuroendocrine tumors (NETs) are considered the most common. However, their metastatic potential and optimal surgical therapy remain ill-defined. Methods: In a retrospective analysis of the National Cancer Database (2004–2015), patients with a diagnosis of MD malignancy were identified. Clinicopathologic factors were extracted and tumors arising in MD were compared. In the subgroup of patients with NET, the association between tumor factors and node involvement was investigated. Results: Three hundred twenty primary MD malignancies were captured in the National Cancer Database, consisting of 280 (87.5%) NET. The median age at diagnosis was 64 years. Patients were predominantly male (207, 73.9%) and white (269, 96.1%). Most tumors were well-differentiated (118, 42.1%) and sub-centimeter (median size, 0.7 cm). Distant metastasis was present in a minority (16, 5.7%), and the median overall survival was 114 months in the entire cohort. The regional lymph node status was known in 87 NET patients, out of which 39 (44.8%) harbored node metastasis. Although the risk of node involvement increased with larger tumor size, it remained significant even among sub-centimeter (9 out of 34, 26.5%) and well-differentiated (18 out of 44, 41%) tumors. Regional node involvement was associated with the presence of distant metastasis (p < 0.001). Conclusion: Lymph node involvement was common irrespective of the size and grade of NET arising from Meckel’s diverticulum. Therefore, regional lymphadenectomy should be considered in the curative-intent surgical management of these neoplasms regardless of tumor size and grade.

Original languageEnglish (US)
JournalJournal of Gastrointestinal Surgery
DOIs
StatePublished - Jan 1 2019

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Meckel Diverticulum
Neuroendocrine Tumors
Lymph Node Excision
Neoplasms
Neoplasm Metastasis
Lymph Nodes
Databases
Small Intestine

Keywords

  • Carcinoid
  • Lymph nodes
  • Lymphadenectomy
  • Meckel’s diverticulum
  • Neuroendocrine tumors
  • Small bowel
  • Small intestine

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

@article{94efaf80b8c540f5a9bfe129ffd0f7ad,
title = "Neuroendocrine Tumors in Meckel’s Diverticulum: Recommendation for Lymphadenectomy Regardless of Tumor Size Based on the NCDB Experience",
abstract = "Background: Meckel’s diverticulum (MD) is an anomaly of the small intestine from which malignancy may arise. Among MD neoplasms, neuroendocrine tumors (NETs) are considered the most common. However, their metastatic potential and optimal surgical therapy remain ill-defined. Methods: In a retrospective analysis of the National Cancer Database (2004–2015), patients with a diagnosis of MD malignancy were identified. Clinicopathologic factors were extracted and tumors arising in MD were compared. In the subgroup of patients with NET, the association between tumor factors and node involvement was investigated. Results: Three hundred twenty primary MD malignancies were captured in the National Cancer Database, consisting of 280 (87.5{\%}) NET. The median age at diagnosis was 64 years. Patients were predominantly male (207, 73.9{\%}) and white (269, 96.1{\%}). Most tumors were well-differentiated (118, 42.1{\%}) and sub-centimeter (median size, 0.7 cm). Distant metastasis was present in a minority (16, 5.7{\%}), and the median overall survival was 114 months in the entire cohort. The regional lymph node status was known in 87 NET patients, out of which 39 (44.8{\%}) harbored node metastasis. Although the risk of node involvement increased with larger tumor size, it remained significant even among sub-centimeter (9 out of 34, 26.5{\%}) and well-differentiated (18 out of 44, 41{\%}) tumors. Regional node involvement was associated with the presence of distant metastasis (p < 0.001). Conclusion: Lymph node involvement was common irrespective of the size and grade of NET arising from Meckel’s diverticulum. Therefore, regional lymphadenectomy should be considered in the curative-intent surgical management of these neoplasms regardless of tumor size and grade.",
keywords = "Carcinoid, Lymph nodes, Lymphadenectomy, Meckel’s diverticulum, Neuroendocrine tumors, Small bowel, Small intestine",
author = "Epameinondas Dogeas and Maximiliano Magallanes and Porembka, {Matthew R.} and Wang, {Sam C.} and Yopp, {Adam C.} and Polanco, {Patricio M.} and Mansour, {John C.} and Choti, {Michael A} and Zeh, {Herbert J.} and Augustine, {Mathew M.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s11605-018-04096-7",
language = "English (US)",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
publisher = "Springer New York",

}

TY - JOUR

T1 - Neuroendocrine Tumors in Meckel’s Diverticulum

T2 - Recommendation for Lymphadenectomy Regardless of Tumor Size Based on the NCDB Experience

AU - Dogeas, Epameinondas

AU - Magallanes, Maximiliano

AU - Porembka, Matthew R.

AU - Wang, Sam C.

AU - Yopp, Adam C.

AU - Polanco, Patricio M.

AU - Mansour, John C.

AU - Choti, Michael A

AU - Zeh, Herbert J.

AU - Augustine, Mathew M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Meckel’s diverticulum (MD) is an anomaly of the small intestine from which malignancy may arise. Among MD neoplasms, neuroendocrine tumors (NETs) are considered the most common. However, their metastatic potential and optimal surgical therapy remain ill-defined. Methods: In a retrospective analysis of the National Cancer Database (2004–2015), patients with a diagnosis of MD malignancy were identified. Clinicopathologic factors were extracted and tumors arising in MD were compared. In the subgroup of patients with NET, the association between tumor factors and node involvement was investigated. Results: Three hundred twenty primary MD malignancies were captured in the National Cancer Database, consisting of 280 (87.5%) NET. The median age at diagnosis was 64 years. Patients were predominantly male (207, 73.9%) and white (269, 96.1%). Most tumors were well-differentiated (118, 42.1%) and sub-centimeter (median size, 0.7 cm). Distant metastasis was present in a minority (16, 5.7%), and the median overall survival was 114 months in the entire cohort. The regional lymph node status was known in 87 NET patients, out of which 39 (44.8%) harbored node metastasis. Although the risk of node involvement increased with larger tumor size, it remained significant even among sub-centimeter (9 out of 34, 26.5%) and well-differentiated (18 out of 44, 41%) tumors. Regional node involvement was associated with the presence of distant metastasis (p < 0.001). Conclusion: Lymph node involvement was common irrespective of the size and grade of NET arising from Meckel’s diverticulum. Therefore, regional lymphadenectomy should be considered in the curative-intent surgical management of these neoplasms regardless of tumor size and grade.

AB - Background: Meckel’s diverticulum (MD) is an anomaly of the small intestine from which malignancy may arise. Among MD neoplasms, neuroendocrine tumors (NETs) are considered the most common. However, their metastatic potential and optimal surgical therapy remain ill-defined. Methods: In a retrospective analysis of the National Cancer Database (2004–2015), patients with a diagnosis of MD malignancy were identified. Clinicopathologic factors were extracted and tumors arising in MD were compared. In the subgroup of patients with NET, the association between tumor factors and node involvement was investigated. Results: Three hundred twenty primary MD malignancies were captured in the National Cancer Database, consisting of 280 (87.5%) NET. The median age at diagnosis was 64 years. Patients were predominantly male (207, 73.9%) and white (269, 96.1%). Most tumors were well-differentiated (118, 42.1%) and sub-centimeter (median size, 0.7 cm). Distant metastasis was present in a minority (16, 5.7%), and the median overall survival was 114 months in the entire cohort. The regional lymph node status was known in 87 NET patients, out of which 39 (44.8%) harbored node metastasis. Although the risk of node involvement increased with larger tumor size, it remained significant even among sub-centimeter (9 out of 34, 26.5%) and well-differentiated (18 out of 44, 41%) tumors. Regional node involvement was associated with the presence of distant metastasis (p < 0.001). Conclusion: Lymph node involvement was common irrespective of the size and grade of NET arising from Meckel’s diverticulum. Therefore, regional lymphadenectomy should be considered in the curative-intent surgical management of these neoplasms regardless of tumor size and grade.

KW - Carcinoid

KW - Lymph nodes

KW - Lymphadenectomy

KW - Meckel’s diverticulum

KW - Neuroendocrine tumors

KW - Small bowel

KW - Small intestine

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U2 - 10.1007/s11605-018-04096-7

DO - 10.1007/s11605-018-04096-7

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AN - SCOPUS:85060980788

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

SN - 1091-255X

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