Endoscopic versus surgical resection of duodenal neuroendocrine neoplasms between 1 and 2 cm: a multi-centered retrospective cohort study
Menée à partir de données 2008-2018 du registre néerlandais des cancers portant sur 138 patients atteints de tumeurs neuroendocrines du duodénum, cette étude analyse la survie globale et la survie sans progression en fonction du type de résection (résection endoscopique ou chirurgicale conventionnelle)
Introduction: Recommendations for resection technique of duodenal neuroendocrine neoplasms (D-NEN) with a size between 1-2 cm are lacking. The primary aim was to compare overall survival (OS) and progression-free survival (PFS) after endoscopic resection (ER) with surgical resection (SR). The secondary aim was to assess the incidence and clinical variables correlated with OS. Methods: Data of patients with D-NENs between 2008 and 2018 were extracted from the Netherlands Cancer Registry and the Dutch Nationwide Pathology Databank. Results: A total of 259 patients were identified, of which 138 were included: 98 (68%) underwent ER and 44 patients (32%) underwent SR. Of these, 38 patients had D-NENs sized between 1 and 2 cm. ER Patients were more frequently male and had a lower T-stage and tumour size than SR patients (all P<0.05). Positive resection margins were observed more frequently after ER compared to SR (71% vs 15%, P<0.005). No patients with tumours between 1-2 cm died after ER or SR (median follow-up 71.8 vs. 52.0 months). PFS rates were not significantly different after ER compared to SR (P=0.672). Recurrence rates were 13% for ER and 7% for SR (P=0.604). Conclusion: Between 2008-2018, the incidence increased from 0.06 to 0.11 per 100,000 patients per year. OS after ER or SR did not differ for D-NEN between 1 and 2 cm. Recurrence and PFS rates were not significantly different. These results suggest that D-NENs sized between 1 and 2 cm could potentially be treated first with ER. Future studies are needed to confirm this hypothesis.