Surgical and Endoscopic Resection of Duodenal Neuroendocrine Tumors Have Similar Disease-Specific Survival Outcome

Q: What is the main research question of this study?

Whether disease-specific survival after surgical resection is similar to that after endoscopic resection for duodenal neuroendocrine tumors across different tumor size categories.

Q: Which database and patient selection criteria were used?

Patients were identified from the SEER database using ICD-O-3 histology and primary-site codes, with exclusions including certain neuroendocrine carcinoma types and cases lacking survival or key data. The analysis focused on dNET cases listed from 2010 to 2015.

Q: How were survival outcomes analyzed?

Disease-specific survival was compared between endoscopic and surgical groups within size strata, using Kaplan–Meier estimates and multivariable Cox proportional hazards models.

Sep 24, 2026

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Background Duodenal neuroendocrine tumors (dNETs) are rare and management strategies are not fully established. NCCN guidance generally favors surgery for larger lesions (>2 cm) and endoscopy for smaller tumors (<2 cm), yet comparative survival evidence across sizes is limited. This retrospective SEER-based study evaluates disease-specific survival after surgical versus endoscopic resection across multiple dNET size strata. Kaplan–Meier and multivariable Cox models assess whether tumor size modifies outcome.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Introduction

Epidemiology and clinical context

Guideline recommendations

Materials and Methods

Data acquisition

Journal of Gastrointestinal Surgery (2023) 27:2365–2372 [https://doi.org/10.1007/s1](https://doi.org/10.1007/s1) 1605-023-05800-y Surgical and Endoscopic Resection of Duodenal Neuroendocrine Tumors Have Similar Disease‑Specific Survival Outcome Sarah Mirzaie1 · JoonY. Park2 · Michael A. Mederos2 · Mark D. Girgis1,2 Received: 28 May 2023 / Accepted: 21 July 2023 / Published online: 8 August 2023 © The Author(s) 2023 Abstract Background Duodenal neuroendocrine tumors (dNETs) are rare, and their management is not well-defined. National Comprehensive Cancer Network (NCCN) guidelines recommend surgical resection of large dNETs (> 2 cm) and endoscopic resection of small tumors (< 2 cm) . We compared the survival outcomes between surgical and endoscopic resection in various dNET sizes. Methods A retrospective cohort study was conducted using patient data from Surveillance, Epidemiology, and End Results Program (SEER) database. Variables analyzed included age, tumor size, grade, stage, and lymph node status. Disease-specific survival (DSS) was compared for endoscopic and surgical groups in dNET size strata: 0–0.5, 0.5–1, 1–2, 2–3, and > 3 cm. Kaplan–Meier and multivariable Cox proportional hazards models were used for survival analysis. Results The study included 465 patients, with 124 (26.7%) undergoing surgical resection. The average age was 61.9 years, and tumor sizes ranged from 0.1 to 10.5 cm. Endoscopic resection had 40.5% of tumors between 0 and 0.5 cm, while surgery had only 21%(p < 0.001) . In the surgical cohort, 79.8% had grade 1 tumors compared to 88.3% in the endoscopy group (P = 0.024) . Among surgically resected cases, 48.4%(60 patients) had lymph node involvement. Age, tumor size, grade, and stage did not significantly predict survival after surgical resection. Stratified by tumor size, no difference in DSS was observed between surgery and endoscopy groups. Conclusions Endoscopic resection demonstrated similar survival outcomes to surgical resection across dNET sizes in this national analysis. Given the risks and the lack of survival benefits for surgery, endoscopic resection may be beneficial for both small and large tumors. Further studies are warranted to validate the current NCCN guidelines. Keywords Duodenal neuroendocrine tumor · Tumor size · NCCN · ENETS · SEER Introduction Duodenal neuroendocrine tumors (dNETs) are rare masses that comprise less than 5% of all neuroendocrine tumors (NETs) .1 In recent decades, widespread utilization of endoscopic screening methods enhanced our ability to identify dNETs, which seemingly increased the incidence of these tumors.1 In general, dNETs tend to have a good prognosis, have small sizes, and are less likely to metastasize; therefore, * Sarah Mirzaie[smirzaie@mednet.ucla.edu](smirzaie@mednet.ucla.edu) 1 David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA 2 Department of Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA tumor resection is often curative for localized dNETs.2 Endoscopic vs surgical resection of dNETs is often selected based on patient characteristics such as age, comorbid status, and surgical history, as well as tumor characteristics including tumor size, grade, and stage.3–5 Tumor resection can be done through either a surgical or endoscopic approach. The National Comprehensive Cancer Network (NCCN) has a proposed set of guidelines for care and management of gastrointestinal NETs of different sizesand locations.6 Although there is robust evidence for clinical approach to gastric, ileal, and rectal NETs, due to the rarity of dNETs and a paucity of data on treatment outcomes for these tumors, recommendations for dNETs management are less clearly defined. NCCN recommends surgical resection for dNETs larger than 2 cm (cm) and endoscopic resection only for tumors smaller than 2 cm.6 European Neuroendocrine Tumor Society (ENETS) recomm

FAQs

What is the main research question of this study?

Whether disease-specific survival after surgical resection is similar to that after endoscopic resection for duodenal neuroendocrine tumors across different tumor size categories.

Which database and patient selection criteria were used?

Patients were identified from the SEER database using ICD-O-3 histology and primary-site codes, with exclusions including certain neuroendocrine carcinoma types and cases lacking survival or key data. The analysis focused on dNET cases listed from 2010 to 2015.

How were survival outcomes analyzed?

Disease-specific survival was compared between endoscopic and surgical groups within size strata, using Kaplan–Meier estimates and multivariable Cox proportional hazards models.

Sep 24, 2026

Uploaded by Blitz