Systematic review: management of localised low‐grade upper gastrointestinal neuroendocrine tumours

Abstract

Background: Neuroendocrine tumours (NETs) of the stomach and duodenum are rare, but are increasing in incidence. Optimal management of localised, low-grade gastric and duodenal NETs remains controversial. Aims:To systematically review recent literature that has evaluated the management of localised low-grade gastric and duodenal NETs. Methods:A systematic literature search was conducted. Articles were screened and eligible articles fully assessed. Additional articles were identified through the included articles' reference lists.Results: Several relevant retrospective case series were identified, but there was considerable heterogeneity between studies and they reported a variety of parameters.Type I gastric NETs had an excellent prognosis and conservative management approaches such as endoscopic surveillance/resection were appropriate in most cases.Many type III gastric NETs were low grade and appeared to have a better prognosis than has previously been appreciated. Endoscopic rather than surgical resection was therefore effective in some patients who had small, low-grade tumours. Duodenal NETs were more heterogenous. Endoscopic resection was generally safe and effective in patients who had small, low-grade, nonfunctional, non-ampullary tumours.However, some patients, especially those with larger or ampullary duodenal NETs, required surgical resection. Conclusions:Most type I gastric NETs behave indolently and surgical resection is only rarely indicated. Some type III gastric and duodenal NETs have a worse prognosis, but selected patients who have small, localised, nonfunctional, low-grade tumours are adequately and safely treated by endoscopic resection. Due to the complexity of this area, a multidisciplinary approach to management is strongly recommended.

A “Watch and Wait” Strategy Involving Regular Endoscopic Surveillance Is Safe for Many Patients with Small, Sporadic, Grade 1, Non-Ampullary, Non-Functioning Duodenal Neuroendocrine Tumours

“…Patient management plans, therefore, need to be personalized and take all these features into account. The current ENETS management guidelines recommend resection of all d-NETs, with the mode of resection being influenced largely by the size of the tumour [8, 15, 16]. A recent study by Gamboa et al [17] supported this argument as the authors demonstrated improved overall survival with any type of resection regardless of tumour size when compared to no resection.…”

“…The most recent ENETS treatment guidelines advocate resection for all d-NETs using either endoscopic or surgical techniques [7]. We recently published a systematic review of the management of localized low-grade upper gastrointestinal NETs and found that a few studies had also reported favourable outcomes for patients who had not undergone resection of small, low-grade, non-functioning, non-ampullary d-NETs [8]. Despite limited follow-up data, Burke et al [9] reported 12 patients who did not undergo any treatment with 11 patients being alive after 11 months of mean follow-up.…”

Diagnostic Features and Management Options for Duodenal Neuroendocrine Neoplasms: A retrospective, Multi-Centre Study

“…The duodenum is thin walled and has a narrow lumen making endoscopic resection more challenging and associated with significant risk of perforation and bleeding [18]. ESD is associated with far greater risk than in the lower GI tact and perforation has been reported in up to 30% of cases in the duodenum [12].…”

“…The current ENETS dNENs management guidelines recommend endoscopic removal of all non-functioning dNENs <1cm [1]. The incidence of complications post endoscopic resection has recently been reported as 8.6% (24/279) in a systematic review of 21 retrospective studies [12].The proportion of resections with tumour present at the margin (R1) has been reported as high as 40% [13].…”

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

“…According to the consensus guidelines of the European Neuroendocrine Tumour Society (ENETS) treatment of D-NETs is mainly guided by tumour size, i.e., tumours <1 cm should be treated endoscopically, tumours >2 cm should be considered for surgical resection whereas treatment of tumours 1-2 cm is not standardized [10]. A recent systematic review identified only few studies reporting outcomes and recurrence rates after treatment of D-NETs and the evidence supporting the current treatment recommendations is limited [17,18]. We therefore aimed to assess the overall survival and recurrence rate in a cohort of patients with D-NETs.…”