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Cirugia Espanola Jul 2023The main objective of this study was to analyse the results of the surgical treatment of ampullary neuroendocrine tumours (NET) based on transduodenal ampullectomy and... (Observational Study)
Observational Study
INTRODUCTION
The main objective of this study was to analyse the results of the surgical treatment of ampullary neuroendocrine tumours (NET) based on transduodenal ampullectomy and pancreatoduodenectomy, in a reference centre in hepatobiliopancreatic pathology.
METHOD
Retrospective, observational study, including all patients operated on for pancreatic and/or duodenal NET in a reference unit of hepatobiliopancreatic pathology and prospectively registered between January 1st, 1993 and September 30th, 2021. For those parameters not present, retrospective research was performed. Demographic, clinical, analytical and pathological data were analysed. A descriptive study was carried out. Overall and disease-free survival was calculated using Kaplan-Meier curves and the Log-Rank test.
RESULTS
Of 181 patients operated on for pancreatic and/or duodenal NET, only 9 were located in the ampulla of Vater, which represents 4.9% of all pancreatic and/or duodenal NET. Pancreatoduodenectomy (PD) was performed in 6 patients, while 3 patients underwent transduodenal ampullectomy (TDA). Longer surgical time and more postoperative complications were observed in the PD group. There were no differences in hospital stay. Overall and disease-free survival at 5 years in the PD group compared to ATD was 83.3% vs. 100% and 50% vs. 100%, respectively.
CONCLUSIONS
Ampullary NET without locoregional involvement or risk factors, can be treated by conservative surgeries such as transduodenal ampullectomy.
Topics: Humans; Ampulla of Vater; Retrospective Studies; Pancreaticoduodenectomy; Duodenal Neoplasms; Neuroendocrine Tumors
PubMed: 36436802
DOI: 10.1016/j.cireng.2022.11.010 -
World Journal of Gastroenterology Nov 2015Superficial non-ampullary duodenal epithelial tumor (SNADET) is defined as a sporadic tumor that is confined to the mucosa or submucosa that does not arise from Vater's... (Review)
Review
Superficial non-ampullary duodenal epithelial tumor (SNADET) is defined as a sporadic tumor that is confined to the mucosa or submucosa that does not arise from Vater's papilla, and it includes adenoma and adenocarcinoma. Recent developments in endoscopic technology, such as high-resolution endoscopy and image-enhanced endoscopy, may increase the chances of detecting SNADET lesions. However, because SNADET is rare, little is known about its preoperative endoscopic diagnosis. The use of endoscopic resection for SNADET, which has no risk of metastasis, is increasing, but the incidence of complications, such as perforation, is significantly higher than in any other part of the digestive tract. A preoperative diagnosis is required to distinguish between lesions that should be followed up and those that require treatment. Retrospective studies have revealed certain endoscopic findings that suggest malignancy. In recent years, several new imaging modalities have been developed and explored for real-time diagnosis of these lesion types. Establishing an endoscopic diagnostic tool to differentiate between adenoma and adenocarcinoma in SNADET lesions is required to select the most appropriate treatment. This review describes the current state of knowledge about preoperative endoscopic diagnosis of SNADETs, such as duodenal adenoma and duodenal adenocarcinoma. Newer endoscopic techniques, including magnifying endoscopy, may help to guide these diagnostics, but their additional advantages remain unclear, and further studies are required to clarify these issues.
Topics: Adenocarcinoma; Biopsy; Diagnosis, Differential; Duodenal Neoplasms; Duodenoscopy; Humans; Image Enhancement; Narrow Band Imaging; Neoplasm Staging; Predictive Value of Tests; Preoperative Care; Reproducibility of Results
PubMed: 26557007
DOI: 10.3748/wjg.v21.i41.11832 -
Surgery Mar 2018To review our experience in patients undergoing operative treatment for duodenal polypoisis associated with familial adenomatous polyposis with an emphasis on operative...
BACKGROUND
To review our experience in patients undergoing operative treatment for duodenal polypoisis associated with familial adenomatous polyposis with an emphasis on operative approach and long-term outcomes.
METHODS
Duodenal polypoisis associated with familial adenomatous polyposis patients undergoing operative treatment were studied retrospectively excluding patients with preoperative duodenal cancer.
RESULTS
Of 767 patients in the database, 63 (8.2%) patients underwent operative treatment: 42 (67%) pancreas-sparing duodenectomy, 15 (24%) pancreatoduodenectomy, and 6 (9.5%) segmental duodenal resection; the majority for Spigelman stages III and IV polyposis. Overall 9.6% had adenocarcinoma postoperatively (28.6% in the pancreatoduodenectomy group; P = .01). The proportion of Spigelman stages III and IV with cancer were 9.5% and 6.5%, respectively. Pathologic upgrade to cancer in patients with low grade dysplasia and high-grade dysplasia on preoperative biopsy was 5.7% and 6.7%, respectively (P = .13). At a median follow-up of 16 years, 7.7% needed a second duodenal polypoisis associated with familial adenomatous polyposis-related operation. Progression to high grade dysplasia or cancer in the stomach occurred in 15.4% of patients. Median overall survival and recurrence-free survival was at least 16 years and 15.6 years. No significant group-based differences were noted on follow-up.
CONCLUSION
The majority of patients with duodenal polypoisis associated with familial adenomatous polyposis can achieve long-term, cancer-free survival with organ-preserving approaches (pancreas-sparing-duodenectomy and segmental-duodenal-resection) with survival not dependent on the type of resection.
Topics: Adenomatous Polyposis Coli; Adult; Disease-Free Survival; Duodenal Neoplasms; Female; Humans; Male; Middle Aged; Neoplasm Staging; Pancreaticoduodenectomy; Retrospective Studies; Survival Rate; Treatment Outcome
PubMed: 29331402
DOI: 10.1016/j.surg.2017.10.035 -
Endoscopy Nov 2016As duodenal neuroendocrine tumors (NETs) are rare, their optimal management has not been clearly established. The aim of this study was to evaluate the feasibility and...
As duodenal neuroendocrine tumors (NETs) are rare, their optimal management has not been clearly established. The aim of this study was to evaluate the feasibility and outcome of endoscopic treatment of duodenal NETs. We reviewed the files of all patients who underwent endoscopic resection of a sporadic duodenal or ampullary NET between 1996 and 2014 at two centers. A total of 29 patients with 32 uT1N0M0 NETs < 20 mm were included. Treatment consisted of endoscopic mucosal resection in 19 cases, and cap aspiration in 13 cases. Prior submucosal saline injection was used in 15 cases. Mortality was 3 % (one severe bleeding). Morbidity was 38 % (11/29). At post-resection analysis, mean tumor size was 8.9 mm (range 3 - 17 mm), 29 lesions were stage pT1, one was pT2, and 2 were pTx because of piecemeal resection. All NETs were well differentiated. A total of 27 lesions were classified as grade 1 and 5 were grade 2. The resection was R0, R1, and Rx for 16, 14, and 2 lesions, respectively. Three R1 patients underwent additional surgical treatment, with no residual tumor on the surgical specimen but with positive metastatic lymph nodes in two cases. One patient was lost to follow-up. Finally, 24 patients were included in the follow-up analysis. The median follow-up period was 56 months (range 6 - 175 months). Two patients presented a tumor recurrence during the follow-up period. Endoscopic treatment of small duodenal NETs was associated with significant morbidity, a difficulty in obtaining an R0 specimen, and the risk of lymph node metastasis. Nevertheless, it represents an interesting alternative in small grade 1 duodenal lesions and in patients at high surgical risk.
Topics: Adult; Aged; Aged, 80 and over; Common Bile Duct Neoplasms; Disease-Free Survival; Duodenal Neoplasms; Endoscopic Mucosal Resection; Feasibility Studies; Female; Humans; Lymphatic Metastasis; Male; Margins of Excision; Middle Aged; Neoplasm Grading; Neoplasm Recurrence, Local; Neoplasm Staging; Neoplasm, Residual; Neuroendocrine Tumors; Reoperation; Survival Rate; Tumor Burden
PubMed: 27494453
DOI: 10.1055/s-0042-112570 -
Pathology International Dec 2018The incidence of lymphoma has rapidly increased over the last 40 years in Japan, following a trend that is very similar to that of breast cancer. In particular, the... (Review)
Review
The incidence of lymphoma has rapidly increased over the last 40 years in Japan, following a trend that is very similar to that of breast cancer. In particular, the relative frequency of follicular lymphoma (FL) has reached that in Western countries. Given its indolence, a "watch-and-wait" approach is often applied to FL patients. We have shown that FL is often detected in the second portion of the duodenum and has a distinct follicular dendritic cell distribution and heavy chain variable usage similar to mucosa-associated lymphoid tissue (MALT) lymphoma. Although the t(14;18)(q32;q21) frequency is the same as in the nodal subtype of FL, there are also ongoing mutations, immunopositivity for cluster of differentiation 10 and B-cell lymphoma (BCL)6, and overexpression of BCL2. Gene expression profiling has shown that it is more similar to gastric MALT lymphoma than to nodal FL. Duodenal-type FL lacks the activation-induced cytidine deaminase (AID) expression observed in nodal ones, although this may be compensated for by BTB domain and CNC homolog 2. Based on these findings, duodenal-type FL has been included in the Revised 4th edition of the World Health Organization classification published in late 2017.
Topics: Duodenal Neoplasms; Humans; Japan; Lymphoma, Follicular
PubMed: 30456840
DOI: 10.1111/pin.12733 -
Digestion 2017Duodenal polyps and especially duodenal adenomas are a rare and mostly coincidental finding in patients undergoing upper gastrointestinal endoscopy. Due to their... (Review)
Review
INTRODUCTION
Duodenal polyps and especially duodenal adenomas are a rare and mostly coincidental finding in patients undergoing upper gastrointestinal endoscopy. Due to their malignant potential, duodenal adenomas should be removed upon diagnosis. So far, the limited available data on the performance of endoscopic polypectomy show conflicting results with regard to adverse events and the adenoma recurrence rate.
PATIENTS AND METHODS
After summarizing the currently available data, we retrospectively analyzed all patients undergoing endoscopic resection of nonampullary duodenal adenomas (NAD) at our institution between 2006 and 2016.
RESULTS
A total of 78 patients underwent endoscopic polypectomy for NAD adenoma. End-of-treatment success with complete resection requiring a mean of 1.2 interventions was achieved in 91% (n = 71). Procedural hemorrhage occurred in 12.8% (n = 10), whereas delayed bleeding was noted in 9% (n = 7). Duodenal perforation was registered and successfully treated in 2 cases (2.6%). No adenoma recurrence was noted following primary complete adenoma resection after a mean follow-up time of 33 months. Acute post-polypectomy bleeding was statistically significantly associated with large polyp size (p = 0.003) and lack of endoscopic prophylaxis (p = 0.0008). Delayed post-polypectomy bleeding showed a trend in the occurrence of large polyps (p = 0.064), and was statistically significantly associated with familial cancer syndrome (p = 0.019) and advanced histopathology (p = 0.013).
CONCLUSION
Our data suggest that endoscopic polypectomy of NAD is well feasible with high success rates. Procedural and delayed hemorrhage seems to be the primary issue rather than adenoma recurrence. We therefore advocate referral of patients with large NAD to experienced centers for endoscopic resection.
Topics: Adenomatous Polyposis Coli; Adult; Aged; Aged, 80 and over; Duodenal Neoplasms; Duodenoscopy; Endoscopic Mucosal Resection; Female; Follow-Up Studies; Humans; Incidence; Intestinal Polyps; Male; Middle Aged; Neoplasm Recurrence, Local; Postoperative Hemorrhage; Retrospective Studies; Switzerland; Treatment Outcome
PubMed: 28854423
DOI: 10.1159/000479625 -
Clinical Journal of Gastroenterology Apr 2023A 61-year-old woman was referred to our hospital for intraductal papillary mucinous neoplasm with no symptoms. Magnetic resonance imaging (MRI) depicted a 15 mm nodular... (Review)
Review
A 61-year-old woman was referred to our hospital for intraductal papillary mucinous neoplasm with no symptoms. Magnetic resonance imaging (MRI) depicted a 15 mm nodular lesion at the descending portion of duodenum. Upper gastrointestinal endoscopy showed a submucosal tumor-like mass at the minor duodenal papilla. A boring biopsy of the tumor revealed a neuroendocrine neoplasm (NEN). Various blood hormone tests were all within normal limits, and the tumor was considered to be nonfunctional. Contrast-enhanced computed tomography showed no obvious distant metastasis, and subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) was performed. Histopathological examination revealed a dense cluster of spindle-shaped cells forming a sheet-like foci and areas showing glandular lumen formation, and immunohistochemistry showed synaptophysin ( + ), chromogranin ( + ). Mitotic rate was about 11 mitoses per 2 square millimeters, Ki-67 index was about 0.2%. She was pathologically diagnosed with NEN G2 at the minor duodenal papilla with regional lymph node metastasis according to the WHO2010 classification. The patient has been currently under outpatient observation with a good postoperative course. Review of the literature identified 43 cases of NENs of the minor duodenal papilla. NENs of the minor duodenal papilla have a high rate of lymph node metastasis, even if the tumor size is small.
Topics: Female; Humans; Middle Aged; Lymphatic Metastasis; Duodenal Neoplasms; Neuroendocrine Tumors; Pancreatic Ducts; Pancreaticoduodenectomy
PubMed: 36542298
DOI: 10.1007/s12328-022-01739-w -
Current Treatment Options in Oncology Oct 2020With the widespread use of esophagogastroduodenoscopy in recent years, the detection rate of superficial non-ampullary duodenal epithelial tumors (SNADETs) is... (Review)
Review
With the widespread use of esophagogastroduodenoscopy in recent years, the detection rate of superficial non-ampullary duodenal epithelial tumors (SNADETs) is increasing. Most SNADETs are early-stage adenocarcinoma or benign conditions, including adenoma. Therefore, endoscopic resection is desirable from the perspective of quality of life. However, endoscopic resection for SNADETs has not yet been established. Endoscopic submucosal dissection (ESD) is the most promising method for the treatment of SNADETs, because ESD provides a high rate of en bloc resection and a low rate of recurrence regardless of the tumor size. However, the difficulty of the procedure and a high rate of severe adverse events including perforation and bleeding have become major problems. Various preventive countermeasures for adverse events, such as use of specific devices, endoscope stabilization methods, and endoscopic closure of the post-ESD ulcer using clips, are reported to reduce the risk of the adverse events of ESD for SNADETs. This article reviews and highlights the current state of ESD for SNADETs and new challenges towards safe and effective ESD.
Topics: Adenocarcinoma; Carcinoma; Duodenal Neoplasms; Endoscopic Mucosal Resection; Humans; Neoplasm Recurrence, Local
PubMed: 33104938
DOI: 10.1007/s11864-020-00796-y -
Digestive Diseases (Basel, Switzerland) 2023Neuroendocrine neoplasms of the ampulla of Vater (ampullary NEN) have features of both gastrointestinal and pancreato-biliary (PB) NEN. However, the limited number of...
BACKGROUND
Neuroendocrine neoplasms of the ampulla of Vater (ampullary NEN) have features of both gastrointestinal and pancreato-biliary (PB) NEN. However, the limited number of studies examining ampullary NEN makes it difficult to clarify their unique characteristics. This study aimed to elucidate the clinical characteristics of ampullary NEN.
METHODS
We enrolled 162 patients with PB-NEN diagnosed at Kyushu University Hospital between 2011 and 2020. Clinical features, pathological diagnoses, treatments, and prognoses were retrospectively analyzed. We also compared ampullary NEN with pancreatic NEN (PanNEN).
RESULTS
We analyzed 10 ampullary NEN cases and 149 PanNEN cases. The ampullary NEN cases consisted of 4 cases of neuroendocrine tumor Grade 1 (NET G1), 1 NET G2 (Grade 2), and 5 neuroendocrine carcinomas (NECs). The incidences of NEC and cholangitis were significantly higher in ampullary NEN than in PanNEN. All ampullary NETs had a submucosal tumor-like appearance, as identified by endoscopic ultrasound-guided fine needle aspiration. We treated small NET G1 (<10 mm) with endoscopic papillectomy and large NET G1 with pancreaticoduodenectomy. There were no cases of recurrence after resection. All ampullary NECs presented with the characteristic endoscopic finding of a "crater sign" similar to deep-mining ulcers seen in gastric malignant lymphoma. Four cases underwent surgical resection, and 1 case was unresectable. Two patients who underwent multidisciplinary treatment were maintained without recurrence for over 2 years.
CONCLUSIONS
Endoscopic findings showed identifiable distinctions between ampullary NETs and NECs.
Topics: Humans; Retrospective Studies; Neuroendocrine Tumors; Prognosis; Pancreaticoduodenectomy; Duodenal Neoplasms; Pancreatic Neoplasms
PubMed: 35588707
DOI: 10.1159/000525013 -
Annali Italiani Di Chirurgia 2021In this study, we aimed to evaluate patients who underwent curative surgical treatment for primary duodenal adenocarcinoma and to present our experience.
AIM
In this study, we aimed to evaluate patients who underwent curative surgical treatment for primary duodenal adenocarcinoma and to present our experience.
MATERIAL AND METHODS
Patients diagnosed with primary duodenal adenocarcinoma between 2006 and 2018 participated in the study. The demographic and clinical characteristics of the patients, details of the operation, pathological features of the tumors, short- and long-term follow-up results, and mean survival were evaluated retrospectively.
RESULTS
Nine patients with a mean age of 54.7 participated in the study. 55% of the patients were male. The most common presenting symptom was abdominal pain (n: 6; 67%). The most common tumor localization was D2-3 (n: 7; 78%), and the most common surgical operation was pancreaticoduodenectomy (n: 7; 78%). There were no intraoperative complications in any patient. The mean tumor diameter was 3.5 cm. The mean number of lymph nodes dissected was 8.3 and the mean number of metastatic lymph nodes was 2. The most common postoperative complication was pancreatic fistula (n: 3; 33%). The mean length of stay was 21.8 days. One patient developed septic shock and mortality happened within the 30-day period. The most common cause of unplanned admission to the hospital within 90 days was wound infection (n: 2; 22%). One patient developed local recurrence and two patients had systemic metastasis. We found an average survival of 40 months.
DISCUSSION
Pancreaticoduodenectomy is the most common approach in its curative surgery and it has a long survival despite the high postoperative complication rate. We recommend radical resection in the surgical treatment of primary duodenal adenocarcinoma.
KEY WORDS
Adenocarcinoma, Duodenum, Pancreaticoduodenectomy.
Topics: Adenocarcinoma; Duodenal Neoplasms; Duodenum; Female; Humans; Male; Neoplasm Recurrence, Local; Pancreatic Neoplasms; Pancreaticoduodenectomy; Retrospective Studies; Treatment Outcome
PubMed: 33746122
DOI: No ID Found