Impact of margin status on outcomes after endoscopic resection of well-differentiated duodenal neuroendocrine tumors

Ragheb, Jonathan; Mony, Shruti; Klapman, Jason; Erim, Tolga; Reagan, Angela; Butler, Robert S.; Dong, Yanbin; Cruise, Michael; Centeno, Barbara A.; Bejarano, P.A.; Stevens, Tyler; Hayat, Umar; Bhatt, Amit

doi:10.1016/j.gie.2021.02.033

Cited by 7 publications

(4 citation statements)

References 18 publications

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“… 6 , 7 Although achieving R0 resection is the ultimate goal for ER, there is a report that argues that margin involvement is not related to recurrence because the remnant tumor cells might be coagulated by the heat of the snare during endoscopic removal. 29 In contrast, Ragheb et al 34 recently reported that a positive margin was a statistically significant risk factor for recurrence. Moreover, the tumor remained at the local site in a positive margin case in the present study, which was surgically resected after ESMR-L.…”

Section: Discussionmentioning

confidence: 96%

Endoscopic mucosal resection using a ligation device for duodenal neuroendocrine tumors: a simple method

Inokuchi

Hayashi

Kaneta

et al. 2022

Clin Med Insights Gastroenterol

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Introduction: Duodenal neuroendocrine tumors (DNETs) smaller than 1 cm in diameter, without invasion to the muscularis propria, have a low risk of metastasis. Therefore, DNETs are frequently resected endoscopically. However, among the various procedures, the best fit for DNET in terms of feasibility, effectiveness, and simplicity is unclear. Methods: Patients with DNET who underwent endoscopic submucosal resection using a ligation device (ESMR-L) at Kanagawa Cancer Center between May 2003 and December 2020 were studied retrospectively to evaluate clinical characteristics and short-term and long-term outcomes. Results: Eleven consecutive patients with 12 lesions were treated with 12 sessions of ESMR-L. Lesions were discovered in patients at a median age of 68 (range, 50–83) years. One patient had two lesions at the time of the initial ESMR-L session. Eleven of the 12 lesions (91.7%) existed in the duodenal bulb, of which 10 (83.3%) were in the anterior wall, and the remaining one (8.3%) existed in the descending part of the duodenum. The en bloc and R0 resection rates were 100% and 75%, respectively. The rates of bleeding and perforation were both 0%. Among the four patients who had non-curative resections, two patients underwent additional surgery after ESMR-L. One patient had a local remnant tumor, and the other had lymph node metastasis. In cases of local remnant tumors, the vertical margin was positive in the ESMR-L specimen. In that case, ligation by the O-ring was insufficient, retrospectively. All patients had no recurrence during the median follow-up period of 5.7 years. Discussion: ESMR-L was the best fit for DNET within the indications for endoscopic resection. It is a simple procedure that enables easy and complete resection of DNETs without complications.

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Section: Discussionmentioning

confidence: 96%

Endoscopic mucosal resection using a ligation device for duodenal neuroendocrine tumors: a simple method

Inokuchi

Hayashi

Kaneta

et al. 2022

Clin Med Insights Gastroenterol

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“…Previous reports have pointed out that the ablation artifact of the resection technique may be the reason for the high incidence of positive or unknown margins 9,10 . In our study, of the 30 patients with adenocarcinomas that underwent EP, 12 had incomplete resection as evidenced by positive or unknown margins in specimens.…”

Section: Discussionmentioning

confidence: 58%

“…Previous reports have pointed out that the ablation artifact of the resection technique may be the reason for the high incidence of positive or unknown margins. 9,10 In our study, of the 30 patients with adenocarcinomas that underwent EP, 12 had incomplete resection as evidenced by positive or unknown margins in specimens. However, except one case with residual lesions after EP, none of the seven cases that were followed up showed recurrence, suggesting that EP achieved complete resection.…”

Section: Discussionmentioning

confidence: 75%

Endoscopic papillectomy could be rewarding to patients with early stage duodenal ampullary carcinoma?

Suzuki,

Kurita,

Kubota

et al. 2023

J Hepato Biliary Pancreat

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Background/PurposeThere is currently no consensus on the use of endoscopic papillectomy (EP) for early stage duodenal ampullary adenocarcinoma. This study aimed to evaluate the feasibility of EP for patients with early stage duodenal ampullary adenocarcinoma.MethodsPatients who underwent EP for ampullary adenocarcinomas were investigated. Complete and clinical complete resection rates were evaluated. Clinical complete resection was defined as either complete resection or resection with positive or unknown margins but no cancer in the surgically resected specimen, or no recurrence on endoscopy after at least a 1‐year follow‐up.ResultsAdenocarcinoma developed in 30 patients (carcinoma in situ [Tis]: 21, mucosal tumors [T1a(M)]: 4, tumors in the sphincter of Oddi [T1a(OD)]: 5). The complete resection rate was 60.0% (18/30) (Tis: 66.7% [14/21], T1a[M]: 50.0% [2/4], and T1a[OD]: 40.0% [2/5]). The mean follow‐up period was 46.8 months. The recurrence rate for all patients was 6.7% (2/30). The clinical complete resection rates of adenocarcinoma were 89.2% (25/28); rates for Tis, T1a(M), and T1a(OD) were 89.4% (17/19), 100% (4/4), and 80% (4/5), respectively.ConclusionsEP may potentially achieve clinical complete resection of early stage (Tis and T1a) duodenal ampullary adenocarcinomas.

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“…In the French retrospective study by Gincul et al, a positive margin rate (R1) as high as 44% was found and, in particular, in the univariate analysis, no significant differences were reported between the resection techniques (EMR/EMR-C) or tumor sizes (whether <10 mm or 10–20 mm), suggesting that the major role in oncological radicality may be played by the resection technique itself instead of by the tumor size [ 17 ]. However, as recently reported, when dNENs < 20 mm are considered, the actual impact of a positive margin status itself (R1) on the risk of recurrence after endoscopic resection has yet to be clarified, since data regarding the statistical significance of this association seem to be contradictory among different studies [ 10 , 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Resection for Duodenal Neuroendocrine Neoplasms between 10 and 20 mm—A Systematic Review and Meta-Analysis

Rossi,

Masoni,

Massironi

et al. 2024

JCM

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Background. The optimal management of duodenal neuroendocrine neoplasms (dNENs) sized 10–20 mm remains controversial and although endoscopic resection is increasingly performed instead of surgery, the therapeutic approach in this setting is not fully standardized. We performed a systematic review of the literature and a meta-analysis to clarify the outcomes of endoscopic resection for 10–20 mm dNENs in terms of efficacy (i.e., recurrence rate) and safety. Methods. A computerized literature search was performed using relevant keywords to identify pertinent articles published until January 2023. Results. Seven retrospective studies were included in this systematic review. The overall recurrence rate was 14.6% (95%CI 5.4–27.4) in 65 patients analyzed, without significant heterogeneity. When considering studies specifically focused on endoscopic mucosal resection, the recurrence rate was 20.5% (95%CI 10.7–32.4), without significant heterogeneity. The ability to obtain the free margin after endoscopic resection ranged between 36% and 100%. No complications were observed in the four studies reporting this information. Conclusions. Endoscopic resection could be the first treatment option in patients with dNENs sized 10–20 mm and without evidence of metastatic disease. Further studies are needed to draw more solid conclusions, particularly in terms of superiority among the available endoscopic techniques.

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Impact of margin status on outcomes after endoscopic resection of well-differentiated duodenal neuroendocrine tumors

Cited by 7 publications

References 18 publications

Endoscopic mucosal resection using a ligation device for duodenal neuroendocrine tumors: a simple method

Endoscopic mucosal resection using a ligation device for duodenal neuroendocrine tumors: a simple method

Endoscopic papillectomy could be rewarding to patients with early stage duodenal ampullary carcinoma?

Endoscopic Resection for Duodenal Neuroendocrine Neoplasms between 10 and 20 mm—A Systematic Review and Meta-Analysis

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