Ahmed M. Gastrointestinal neuroendocrine tumors in 2020. World J Gastrointest Oncol 2020; 12(8): 791-807 [PMID: 32879660 DOI: 10.4251/wjgo.v12.i8.791]
Corresponding Author of This Article
Monjur Ahmed, FACG, FACP, FASGE, FRCP, MD, Associate Professor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Thomas Jefferson University, 132 South 10th Street, Main Building, Suite 468, Philadelphia, PA 19107, United States. monjur.ahmed@jefferson.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
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Surgical resection or enucleation of the tumor without pancreaticoduodenectomy for nonmetastatic duodenal gastrinoma. In patients with duodenal gastrinoma with hepatic metastasis treatment options include hormonal therapy with octreotide, chemotherapy (streptozocin, doxorubicin, 5- fluorouracil), radiotherapy with yttrium 90-DOTA-lanreotide, hepatic embolization alone or with chemoembolization, cytoreductive surgery and liver transplantation
Endoscopic resection should be adequate if the NET is less than 1 cm. Transduodenal excision should be done for 1-2 cm tumor. But Whipple’s surgery with local lymph node resection should be considered for more than 2 cm tumor
Endoscopic resection or radical excision including pancreaticoduodenectomy depending on the size, depth of invasion and lymph node metastasis
Transduodenal resection is indicated for d-NETs invading the muscularis propria. Radial surgery is advocated for d-NETs > 2 cm in diameter, d-NETs with lymph nodes involvement and all peri-ampullary d-NETs
radical surgery or chemotherapy
Table 4 Appendiceal neuroendocrine tumor: Size and surgery
Appendiceal NET size
Surgery
< 1 cm
Simple appendectomy
1 cm to 2 cm
Appendectomy and periodic post-operative follow up is recommended for 5 yr. Right hemicolectomy should be considered in the presence of involvement of base of the appendix, cecal infiltration, invasion into the mesoappendix or serosa, involvement of tumor margin, positive lymph nodes, lymphovascular invasion, presence of goblet cells or poorly differentiated cells, Ki67 index > 2% or MiNEN
> 2 cm
Right hemicolectomy within 3 mo from the time of appendectomy but staging work up is required. This includes multiphasic computerized tomography or magnetic resonance imaging of abdomen and pelvis. SRS-based scan (Octreoscan) or (68)Ga-DOTATE PET/CT, serum CgA, 24 h 5-HIAA and colonoscopy to evaluate for synchronous colorectal cancer
Citation: Ahmed M. Gastrointestinal neuroendocrine tumors in 2020. World J Gastrointest Oncol 2020; 12(8): 791-807