scholarly journals Disección endoscópica submucosa de tumor neuroendocrino primario de duodeno. Reporte de caso y revisión de la literatura

2020 ◽  
Vol 50 (2) ◽  
Author(s):  
Martín Edgardo Rojano Rodríguez ◽  
Elisafat Arce Liévano ◽  
Orlando Bada Yllán ◽  
Carlos Valenzuela Salazar ◽  
Roberto Délano Alonso ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Neuroendocrine Tumours ◽  
Neuroendocrine Tumour ◽  
Low Frequency ◽  
Resection Margins ◽  
R0 Resection ◽  
Nodal Involvement ◽  
Mucosal Layer ◽  
Duodenal Neuroendocrine Tumours ◽  
Duodenal Carcinoid

Background. Duodenal neuroendocrine tumours are very rare, if they are limited to the mucosal layer and have no nodal involvement, endoscopic resection may be curative. Case report. We present the case of a Mexican 52 years old female with a duodenal neuroendocrine tumour who underwent successful endoscopic submucosal dissection with no complications. Pathology of the specimen revealed a complete R0 resection with negative resection margins. Endoscopic biopsies 4 weeks later showed no malignant cells. Conclusions. Because of their low frequency the management of primary duodenal carcinoid tumours is controversial; for tumours less than 1 cm endoscopic resection is recommended, for those bigger than 2 cm surgical resection is advised. Management of tumours between 1 and 2 cm is controversial and should be individualized.

scholarly journals A82 SUCCESSFUL RESECTION OF GRADE 1 DUODENAL NEUROENDOCRINE TUMOURS USING ENDOSCOPIC TECHNIQUES IN TWO CANADIAN HOSPITALS

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 96-97
Author(s):  
N K Klemm ◽  
D Lu-Cleary ◽  
D Chahal ◽  
R Trasolini ◽  
E Lam ◽  
...  
Keyword(s):  
Literature Review ◽  
Endoscopic Resection ◽  
Neuroendocrine Tumours ◽  
Residual Disease ◽  
Duodenal Bulb ◽  
Muscularis Propria ◽  
Duodenal Perforation ◽  
En Bloc ◽  
Well Differentiated ◽  
Duodenal Neuroendocrine Tumours

Abstract Background Given the rarity of duodenal neuroendocrine tumours (dNETs), limited guidelines exist for resection of well-differentiated, ≤10 mm dNETS. As incidence rises, alternatives to surgery are valuable. We present 9 cases of endoscopic dNET resections and a literature review. Aims To demonstrate efficacy and safety of endoscopic resection for dNETs ≤10 mm at 2 Canadian hospitals. Methods We retrospectively analyzed data on 7 patients that had endoscopic dNET resection from 2013–2018. Endoscopic resection occurred if dNETs were ≤10 mm in diameter, did not extend to the muscularis propria and lymphovascular invasion was absent. WHO 2017 classification was used. Results All patients had biopsies and 5 (71%) had EUS prior to resection; 4 females and 3 males underwent resection of 9 dNETs; 2 via cap-assisted snare polypectomy; 4 with cap-assisted band mucosectomy; and 2 over-the-scope clip-assisted resection. The median size was 10 mm (4–11); 6 (67%) dNETS were found in the duodenal bulb, 2 at the D1/D2 junction and 1 in D2 alone. The median age was 68.5 (50–79) years. All dNETs were submucosal and well-differentiated. The dNETs were resected en bloc, but 3 did not have clear margins. Two procedures were complicated by duodenal perforation; 1 requiring surgery and 18 days in hospital. One case was complicated by bleeding with successful endoscopic hemostasis. The majority (75%) of resections were day procedures. Patients were followed for 6–12 months with an EGD or chromogrannin A. None of the patients had endoscopic residual disease, but 1 patient required a second procedure to remove a dNET left in situ following the initial resection of 2 dNETs 12 months earlier. In our literature review of 178 patients, the majority of dNETs were resected by EMR 81% (150/185) versus ESD, similar to our experience. Patients were slightly younger with a mean age of 63.28, and most dNETs (46%) were found in the duodenal bulb. Complications included intraoperative bleeding, perforation and death in 17 (9.55%), 9 (5.06%) and 1 (0.06%) patient(s) respectively. The rate of recurrence was 4/178 (2.25%) and patients had a mean follow up of 26.1 months. Conclusions Well-differentiated dNETs ≤10 mm in diameter can be successfully resected endoscopically. Complications can be managed intraoperatively and hospital stay remains minimal. Funding Agencies None

Outcomes of Surgical and Endoscopic Resection of Duodenal Neuroendocrine Tumours (NETs): a Systematic Review of the Literature

2018 ◽  
Vol 22 (9) ◽  
pp. 1652-1658 ◽  
Author(s):  
Bobby V. M. Dasari ◽  
Sarah Al-Shakhshir ◽  
Timothy M. Pawlik ◽  
Tahir Shah ◽  
Ravi Marudanayagam ◽  
...  
Keyword(s):  
Systematic Review ◽  
Endoscopic Resection ◽  
Neuroendocrine Tumours ◽  
Review Of The Literature ◽  
Duodenal Neuroendocrine Tumours

Combined chemotherapy and EUS-guided intra-tumoral 32-P implantation for locally advanced pancreatic ductal adenocarcinoma: a pilot study

Endoscopy ◽  
2021 ◽  
Author(s):  
Jeevinesh Naidu ◽  
Dylan Bartholomeusz ◽  
Joshua Zobel ◽  
Romina Safaeian ◽  
William Hsieh ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Adelaide Hospital ◽  
Response To Treatment ◽  
Ductal Adenocarcinoma ◽  
Resection Margins ◽  
R0 Resection ◽  
Royal Adelaide Hospital ◽  
Combined Chemotherapy ◽  
Radioactive Phosphorus ◽  
18Fdg Pet

Aim: This study evaluated clinical outcomes of combined chemotherapy and Endoscopic Ultrasound (EUS) guided intra-tumoral radioactive phosphorus-32 (32P OncoSil) implantation in locally advanced pancreatic adenocarcinoma (LAPC). Methods: Consecutive patients with a new histological diagnosis of LAPC were recruited over 20 months. Baseline CT and 18FDG PET-CT were performed and repeated after 12 weeks to assess response to treatment. Following 2 cycles of conventional chemotherapy, patients underwent EUS-guided 32P OncoSil implantation followed by a further six cycles of chemotherapy. Results: Twelve patients with LAPC (8M:4F; median age 69 years, IQR 61.5-73.3) completed the treatment. Technical success was 100% and no procedural complications were reported. At 12 weeks, there was a median reduction of 8.2cm3 (95% CI 4.95-10.85; p=0.003) in tumour volume, with minimal or no 18FDG uptake in 9 (75%) patients. Tumour downstaging was achieved in 6 (50%) patients, leading to successful resection in 5 (42%) patients, of which 4 patients (80%) had clear (R0) resection margins. Conclusions: EUS guided 32P OncoSil implantation is feasible and well tolerated and was associated with a 42% rate of surgical resection in our cohort. However, further evaluation in a larger randomized multicenter trial is warranted. (32P funded by OncoSil Medical Ltd, equipment and staff funded by the Royal Adelaide Hospital, ClinicalTrials.gov number, NCT03003078).

scholarly journals Survival and Disease Recurrence in Patients with Duodenal Neuroendocrine Tumours—A Single Centre Cohort

Cancers ◽  
2021 ◽  
Vol 13 (16) ◽  
pp. 3985
Author(s):  
Oddry Folkestad ◽  
Hans H. Wasmuth ◽  
Patricia Mjønes ◽  
Reidun Fougner ◽  
Øyvind Hauso ◽  
...  
Keyword(s):  
Overall Survival ◽  
Recurrence Rate ◽  
Surgical Resection ◽  
Endoscopic Treatment ◽  
Neuroendocrine Tumours ◽  
Disease Recurrence ◽  
Tumour Grade ◽  
Single Centre ◽  
Duodenal Neuroendocrine Tumours

Background: Duodenal neuroendocrine tumours (D-NETs) are rare but increasingly diagnosed. This study aimed to assess the overall survival and recurrence rate among patients treated for D-NETs. Methods: Patients with D-NETs were retrospectively reviewed with a median follow-up time of 4.8 years (range 0.0–17.2 years). Results: A total of 32 patients with median age 68.0 years were identified. Fifteen patients underwent surgery while ten patients underwent endoscopic treatment. Mean estimated overall survival for the entire population was 12.1 years (95% CI 9.5–14.7 years), while 5-year overall survival was 81.3%. Tumour grade G1 was associated with longer mean estimated survival compared to G2 tumours (13.2 years versus 4.4 years, p = 0.010). None of the 23 patients who underwent presumed radical endoscopic or surgical resection had disease recurrence during follow-up. Tumours <10 mm could be treated endoscopically whereas a high proportion of patients with tumours 10–20 mm should be considered for surgery. Conclusion: Patients with D-NETs had long overall survival, and mortality was more influenced by other diseases. Both endoscopic and surgical resections were effective as no recurrences were diagnosed during follow-up.

1028 - Endoscopic Resection of Duodenal Carcinoid Tumors: A Single Center Comparison Between Simple Polypectomy and Endoscopic Mucosal Resection

2018 ◽  
Vol 154 (6) ◽  
pp. S-196-S-197
Author(s):  
Nadim Mahmud ◽  
Yutaka Tomizawa ◽  
Kristen M. Stashek ◽  
Bryson W. Katona ◽  
David C. Metz
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Endoscopic Resection ◽  
Carcinoid Tumors ◽  
Single Center ◽  
Mucosal Resection ◽  
Duodenal Carcinoid

705 SIGNIFICANCE OF CLEAR CIRCUMFERENTIAL RESECTION MARGIN IN ESOPHAGEAL CANCER

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Catherine Cheang ◽  
Pradeep Patil
Keyword(s):  
Esophageal Cancer ◽  
Multimodal Therapy ◽  
Resection Margin ◽  
Locally Advanced ◽  
Radical Resection ◽  
Resection Margins ◽  
R0 Resection ◽  
Term Survival ◽  
R1 Resection

Abstract   Circumferential resection margins (CRM) of an esophagectomy specimen for oesophageal cancer is a key prognostic factor of overall survival (OS). This retrospective study aims to compare OS of post-esophagectomy patients with CRM of &gt;1 mm (R0) and &lt; 1 mm (R1) with further subgroup analysis of locally advanced T3R0 vs T3R1 resection. Methods A total of 110 esophagectomies conducted between 2010 and 2020 were analysed. We recorded R stage based on pathological CRM &gt;1 mm (R0) or &lt; 1 mm (R1). OS was calculated from the day of surgery to day of death or otherwise censored. All patients underwent multimodal therapy including chemotherapy and similar pre-surgical and post-surgical management. 58 of these patients with pT3 stage esophageal cancer (EC) were selected and compared. Statistical analysis was carried out using SPSS. Results Of 110 patients, 78 (71.5%) patients had a R0 resection. Mean OS in R0 resections was 73 months (6 years) compared to 25.2 months (2 years) in R1 resection (p = 0.001). 58 of the 110 patients were pathological stage T3(pT3) despite downstaging with chemotherapy showing the burden of advanced disease. In patients with stage pT3 (n = 58), 32 patients were R0 resections, and 26 patients had R1 resections. Mean OS in T3R0 resections was 51.5 months compared to 28.5 months in T3R1 resection. OS comparison is significant (p = 0.011). Conclusion This study emphasizes the importance of clear CRM in all patients and especially in locally advanced pT3/T4a esophageal cancer in achieving long term survival. Techniques used to ensure a clear CRM such multimodality therapy combined with surgical radical resection concepts such as mesoesophagectomy should be employed.

Resection Status Does Not Impact Recurrence in Well-Differentiated Liposarcoma of the Extremity

2021 ◽  
pp. 000313482110545
Author(s):  
Chelsea R. Olson ◽  
Lorena P. Suarez-Kelly ◽  
Cecilia G. Ethun ◽  
Rita D. Shelby ◽  
Peter Y. Yu ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Resection Margins ◽  
R0 Resection ◽  
Low Grade ◽  
Incomplete Resection ◽  
R1 Resection ◽  
Increased Risk ◽  
Clinicopathologic Factors ◽  
Resection Margin Status ◽  
Well Differentiated

Background Well-differentiated liposarcoma (WDLPS) is a low-grade soft tissue sarcoma with a propensity for local recurrence. The necessity of obtaining microscopically free surgical margins (R0) to minimize local recurrence is not clear. This study evaluates recurrence-free survival (RFS) of extremity WDLPS in relation to resection margin status. Methods A retrospective review of adult patients with primary extremity WDLPS at seven US institutions from 2000 to 2016 was performed. Patients with recurrent tumors or incomplete resection (R2) were excluded. Clinicopathologic factors were analyzed to assess impact on local RFS. Results 97 patients with primary extremity WDLPS were identified. The majority of patients had deep, lower extremity tumors. Mean tumor size was 18.2±8.9cm. Patients were treated with either radical (76.3%) or excisional (23.7%) resections; 64% had R0 and 36% had microscopically positive (R1) resection margins. Ten patients received radiation therapy with no difference in receipt of radiation between R0 vs R1 groups. Thirteen patients (13%) developed a local recurrence with no difference in RFS between R0 vs R1 resection. Five-year RFS was 59.5% for R0 vs 85.2% for R1. Only one patient died of disease after developing dedifferentiation and distant metastasis despite originally having an R0 resection. Discussion In this large multi-institutional study of surgical resection of extremity WDLPS, microscopically positive margins were not associated with an increased risk of recurrence. Positive microscopic margin resection for extremity WDLPS may yield similar rates of local control while avoiding a radical approach to obtain microscopically negative margins.

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