Duodenal Neuroendocrine Tumors: Location Matters!

2016 ◽  
Vol 82 (5) ◽  
pp. 386-389
Author(s):  
Mohd Raashid Sheikh ◽  
Houssam Osman ◽  
Susannah Cheek ◽  
Shanee Hunter ◽  
Dhiresh Rohan Jeyarajah
Keyword(s):  
Lymph Node ◽  
Neuroendocrine Tumors ◽  
Clinical Presentation ◽  
Positive Lymph Node ◽  
Factors Associated ◽  
Aggressive Surgical Approach ◽  
Duodenal Resection ◽  
Operative Findings ◽  
Duodenal Neuroendocrine Tumors ◽  
Transduodenal Excision

Duodenal neuroendocrine tumors (NETs) are rare. Historically, when feasible a less aggressive surgical approach is considered. The aim of this study was to identify factors associated with prognosis and the necessity for more aggressive surgical procedures. All patients who underwent surgery for duodenal NETs between September 2005 and June 2014 were identified retrospectively. Data collected included clinical presentation, operative findings, and histopathological data. Eighteen patients underwent surgical management for duodenal NETs. Two patients underwent transduodenal excision (11%), two patients had partial duodenal resection (11%), two patients had antrectomy including 1st part of duodenum (D1) resection (33%), and eight underwent pancreaticoduodenectomy [PD (44%)]. On analysis, 2nd part of duodenum (D2) location was the most common site of duodenal NETs (n = 9, 50%). The odds of having a PD were 10 times higher when the lesion was in D2 location. The odds of having a positive lymph node are nine times higher when the lesion is in D2 region. The odds of having a positive lymph node are three times higher when lesion is greater than T1. D2 location of NETs is associated with higher odds of lymph node positivity and need for more extensive procedures like PD.

Utility and factors associated with imaging early-stage breast cancer: Are we choosing wisely?

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 52-52
Author(s):  
Ana I. Velazquez Manana ◽  
Nina Nguyen ◽  
Carlos Rodriguez Bonilla ◽  
Theresa Shao
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Early Stage ◽  
Positive Lymph Node ◽  
Young Age ◽  
Stage I ◽  
Choosing Wisely ◽  
Factors Associated ◽  
Routine Imaging

52 Background: Breast cancer (BC) is the most common malignancy in women with estimated care costs of $20.50 billion/year by 2020. In 2012, ASCO released the Choosing Wisely Initiative which recommended against the use of routine imaging in patients with newly diagnosed early stage BC. We examined the adherence rate and factors associated with non-adherence in patients with early stage BC treated within a large health care system. Methods: We identified all women with stage I-II BC diagnosed between January 1, 2014 and December 31, 2015 from the Cancer Registry of Mount Sinai Health System. Demographic, clinical and treatment related factors were collected. Medical records were reviewed to identify patients who had routine staging scan. Data of initial and follow-up imaging over 1-year period were collected. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from logistic regression models. Results: Among 733 BC patients, the median age at diagnosis was 58 (range 26-98). One hundred thirty nine patients (19%) had routine imaging with a mean number of initial scans of 1.53 and 59 (42%) patients had at least 1 subsequent scan in the 1-year follow up (range 1-4 scans/year). PET/CT was the most frequent modality, followed by CT. Medical oncologist was the ordering provider in 52% of the cases and surgical oncologist in 44.6%. Routine scan identified no cases of metastatic disease. False-positive findings were identified in 43% and incidental findings in 8% of cases. Total cost of imaging in this group was $4480/patient. Young age ( < 50), TN disease, tumor size > 2cm and positive lymph node were associated with increased staging scan on univariate and multivariate analysis. Conclusions: Our study highlights the prevalence of unnecessary scan in up to 19% of patients with stage I-II BC. Routine imaging resulted in increased radiation exposure and additional cost of $4480/patient. The presence of T2 tumor, positive lymph node, TN disease and young age were associated with increased staging scan. Further educational efforts are needed to avoid unnecessary scans in patients with early stage BC. [Table: see text]

scholarly journals Risk factors for lymph node metastasis in duodenal neuroendocrine tumors

Medicine ◽  
2019 ◽  
Vol 98 (23) ◽  
pp. e15885 ◽  
Author(s):  
Sang Gyu Park ◽  
Bong Eun Lee ◽  
Gwang Ha Kim ◽  
Joon Woo Park ◽  
Moon Won Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Neuroendocrine Tumors ◽  
Node Metastasis ◽  
Duodenal Neuroendocrine Tumors

Incidence of Lymph Node Metastases and Impact of Radical Surgery for Duodenal Neuroendocrine Tumors

2021 ◽  
Vol 268 ◽  
pp. 419-431
Author(s):  
Yuki Fujii ◽  
Ching-Wei Tzeng ◽  
Yi-Ju Chiang ◽  
Daniel M. Halperin ◽  
Arvind Dasari ◽  
...  
Keyword(s):  
Lymph Node ◽  
Neuroendocrine Tumors ◽  
Lymph Node Metastases ◽  
Radical Surgery ◽  
Node Metastases ◽  
Duodenal Neuroendocrine Tumors

ID: 3523621 DUODENAL NEUROENDOCRINE TUMORS AND LYMPH NODE METASTASIS

2021 ◽  
Vol 93 (6) ◽  
pp. AB339-AB340
Author(s):  
David M. Roth ◽  
Theresa W. Gillespie ◽  
Vaishali Patel ◽  
Ambreen A. Merchant ◽  
Saurabh Chawla ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Neuroendocrine Tumors ◽  
Node Metastasis ◽  
Duodenal Neuroendocrine Tumors

A multi-institutional analysis of duodenal neuroendocrine tumors: Tumor biology rather than extent of resection to dictate prognosis.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 255-255
Author(s):  
Georgios A Margonis ◽  
Mario Samaha ◽  
Yuhree Kim ◽  
Lauren McLendon Postlewait ◽  
Shishir Kumar Maithel ◽  
...  
Keyword(s):  
Lymph Node ◽  
Neuroendocrine Tumors ◽  
Metastatic Lymph Node ◽  
Perioperative Complications ◽  
Tumor Biology ◽  
Surgical Margin ◽  
Local Approach ◽  
Curative Intent ◽  
Symptomatic Disease ◽  
Duodenal Neuroendocrine Tumors

255 Background: Duodenal neuroendocrine tumors (NETs) are rare neoplasms and their management is poorly defined. As such, we sought to evaluate the management and outcomes of patients undergoing resection of duodenal NETs. Methods: Using a multi-institutional database, 132 patients who underwent curative-intent resection for duodenal NETs between 1998 and 2015 were identified. Data on clinical characteristics, comorbidities, procedural details, as well as recurrence-free survival (RFS) were collected and analyzed. Results: Median age was 63 years and most patients were male(52.3%). Two-thirds(66.7%) of patients had symptomatic disease. Most patients presented with abdominal pain(47.8%), while 17(19.3%) patients presented with GI bleeding/anemia. Lesions were located in first/second(94.5%) or third/fourth(5.5%) portion of the duodenum. Median tumor size was 1.7 cm. Local surgical resection(LSR) was performed in 55(42.0%) patients, while 47(35.9%) patients underwent pancreaticoduodenectomy(PD) and 29(22.1%) underwent an endoscopic resection(ER). Most patients had an R0 surgical margin(88.4%)(LSR, 88.7% vs. PD, 95.7% vs. ER, 71.4%; P = 0.02). Among patients who had at least one lymph node examined(n = 86), 49(57.0%) had a metastatic lymph node; lymph node metastasis were more common among patients with tumors ≥ 2cm(OR = 3.21, P = 0.02). Median length-of-stay was longer for PD(11 days) versus LSR(7 days)(P < 0.001). PD patients had more complications(LSR, 52.7% vs. PD, 63.8% vs. ER, 6.9%; P < 0.001). 3- and 5-year RFS was 80.1%, and 69.6%, respectively (site of recurrence: locoregional, n = 8 vs. distant, n = 14). Factors associated with worse RFS included tumor grade(moderate-to-poor: HR 4.12) and presence of metastasis at diagnosis (HR 5.66)(both P < 0.05). PD versus LSR versus ER approach was not associated with RFS (P > 0.05). Conclusions: Recurrence of duodenal NETs was dependent on tumor biology rather than procedure type. PD was associated with a longer hospital stay and higher risk of perioperative complications. For patients with tumors < 2cm, LSR or ER may be appropriate with PD reserved for larger lesions and those not amenable to a more local approach.

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