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Is endoscopic resection appropriate for type 3 gastric neuroendocrine tumors? A retrospective multicenter study.
Dig Endosc. 2020 Jun 23 [Online ahead of print]DE

Abstract

BACKGROUND

Gastrectomy with lymphadenectomy is recommended for type 3 gastric neuroendocrine tumors (G-NETs). This study aimed to identify the risk factors for lymph node metastasis (LNM) arising from G-NETs to assess the suitability of endoscopic resection (ER).

METHODS

Nationwide clinicopathological data of patients with type 3 G-NETs who underwent surgery or ER were collected. A single pathologist graded the histological tumor specimens.

RESULTS

Among 176 cases from 53 institutions, 144 were eligible for analysis (90 NET-G1 and 54 NET-G2 grade, 8-mm median-size tumors). Of these, 63 patients had undergone ER (15 with additional surgeries). Histological data regarding LNM were available for 93 surgical patients. LNM was confirmed in 15 (16%) tumors and was correlated with tumor diameter, invasion depth, and tumor grade. LNM was negative in 6 tumors ≤5 mm, confined to the mucosa or submucosa, with a grade of G1, and without lymphovascular invasion, but the number of cases was too small to propose ER indications. Among 48 patients treated with ER alone, only 1 developed recurrence; no mortality was observed at follow-up, although many patients were classified with SM2/NET-G2/tumors >5 mm. This suggests that not all LNMs arising from small G-NETs are fatal.

CONCLUSION

Gastrectomy with lymphadenectomy for Type 3 G-NETs is recommended on the basis of lymph node metastasis. However, ER for type 3 G-NETs ≤10 mm, confined to the mucosa or submucosa, with a grade of G1 has shown excellent survival outcomes despite the risk of LNM, and therefore, could be an alternative treatment option.

Authors+Show Affiliations

Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.Department of Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32578248

Citation

Hirasawa, Toshiaki, et al. "Is Endoscopic Resection Appropriate for Type 3 Gastric Neuroendocrine Tumors? a Retrospective Multicenter Study." Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society, 2020.
Hirasawa T, Yamamoto N, Sano T. Is endoscopic resection appropriate for type 3 gastric neuroendocrine tumors? A retrospective multicenter study. Dig Endosc. 2020.
Hirasawa, T., Yamamoto, N., & Sano, T. (2020). Is endoscopic resection appropriate for type 3 gastric neuroendocrine tumors? A retrospective multicenter study. Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society. https://doi.org/10.1111/den.13778
Hirasawa T, Yamamoto N, Sano T. Is Endoscopic Resection Appropriate for Type 3 Gastric Neuroendocrine Tumors? a Retrospective Multicenter Study. Dig Endosc. 2020 Jun 23; PubMed PMID: 32578248.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is endoscopic resection appropriate for type 3 gastric neuroendocrine tumors? A retrospective multicenter study. AU - Hirasawa,Toshiaki, AU - Yamamoto,Noriko, AU - Sano,Takeshi, Y1 - 2020/06/23/ PY - 2020/6/25/entrez JF - Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society JO - Dig Endosc N2 - BACKGROUND: Gastrectomy with lymphadenectomy is recommended for type 3 gastric neuroendocrine tumors (G-NETs). This study aimed to identify the risk factors for lymph node metastasis (LNM) arising from G-NETs to assess the suitability of endoscopic resection (ER). METHODS: Nationwide clinicopathological data of patients with type 3 G-NETs who underwent surgery or ER were collected. A single pathologist graded the histological tumor specimens. RESULTS: Among 176 cases from 53 institutions, 144 were eligible for analysis (90 NET-G1 and 54 NET-G2 grade, 8-mm median-size tumors). Of these, 63 patients had undergone ER (15 with additional surgeries). Histological data regarding LNM were available for 93 surgical patients. LNM was confirmed in 15 (16%) tumors and was correlated with tumor diameter, invasion depth, and tumor grade. LNM was negative in 6 tumors ≤5 mm, confined to the mucosa or submucosa, with a grade of G1, and without lymphovascular invasion, but the number of cases was too small to propose ER indications. Among 48 patients treated with ER alone, only 1 developed recurrence; no mortality was observed at follow-up, although many patients were classified with SM2/NET-G2/tumors >5 mm. This suggests that not all LNMs arising from small G-NETs are fatal. CONCLUSION: Gastrectomy with lymphadenectomy for Type 3 G-NETs is recommended on the basis of lymph node metastasis. However, ER for type 3 G-NETs ≤10 mm, confined to the mucosa or submucosa, with a grade of G1 has shown excellent survival outcomes despite the risk of LNM, and therefore, could be an alternative treatment option. SN - 1443-1661 UR - https://www.unboundmedicine.com/medline/citation/32578248/Is_endoscopic_resection_appropriate_for_type_3_gastric_neuroendocrine_tumors_A_retrospective_multicenter_study L2 - https://doi.org/10.1111/den.13778 DB - PRIME DP - Unbound Medicine ER -
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