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Paper 1 (0815)
CARCINOID TUMORS OF THE DUODENUM
Background. Carcinoid tumors of the duodenum are rare, and consequently there is no consensus as to the optimal extent of surgical treatment, including the need for full-thickness duodenal resection and regional lymphadenectomy.
The 26th Annual Meeting of the American
Association of Endocrine Surgeons
April 3rd- 5th,2005 - Paradisus Riviera Cancun.
John Mullen, MD, Huamin Wang, MD, PhD, James Yao, MD, Nancy Perrier, MD, Jeffrey Lee, MD, and Douglas Evans, MD
The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Methods. We reviewed the records of all patients with primary carcinoid tumors of the duodenum treated at our institution from 1969-2004. Patients with neuroendocrine neoplasms of the ampulla or gastrinomas were excluded. All known clinical and histological risk factors for metastasis were examined and their association with recurrence and survival determined.
Results. Twenty-four patients had histologically confirmed duodenal carcinoids, which were multifocal in 4 (17%) patients. Treatment included endoscopic resection (6), local excision (4), segmental resection (8), pancreaticoduodenectomy (2), and subtotal radical resection (1). In 3 patients the duodenal carcinoid was identified incidentally in the pathology specimen. The median tumor size was 7.5 mm (range 2 mm - 9 cm) with 20 (83%) of 24 measuring less than 2 cm in greatest diameter. The depth of invasion was known for 21 tumors, of which 16 (76%) were limited to the mucosa or submucosa. Lymph nodes were identified in the surgical specimen in 13 patients and metastases were present in 7 (54%), including 2 patients with tumors <1 cm and limited to the submucosa. At a mean follow-up of 46 months, overall disease-specific survival was 100% and only 2 patients have recurred (in regional lymph nodes). No patient has developed distant metastases or the carcinoid syndrome.
Conclusions. Carcinoid tumors of the duodenum are indolent, exhibiting a less aggressive natural history than that of midgut carcinoids. Importantly, the presence of regional lymph node metastases cannot be accurately predicted on the basis of tumor size or depth of invasion but rather appears to be a function of the extent of surgery and pathologic analysis. The impact of lymph node metastases on survival is unclear and may be analogous to the experience with papillary thyroid cancer.