Table 5.
Therapy of duodenal neuroendocrine tumors (without multiple endocrine neoplasia type 1)
| NET G1 without risk factors (for metastatic disease) | Risk factorsa | ||
|---|---|---|---|
| Size | ≤1 cm | 1–2 cm | mostly ≥2 cm |
| Sporadic NET | EMRbc | EMRc or surgeryd | surgeryd |
| Sporadic gastrinoma (localized) | surgeryd | surgeryd | surgeryd |
a
Risk factors for metastatic disease are angioinvasion, G2–G3 histological grading, infiltration of the muscularis propria, enlarged regional lymph nodes, or tumor size ≥2 cm.
b
In the elderly, asymptomatic duodenal NET G1 ≤ 1 cm may just be followed up [44].
c
EMR may be considered for NET G2 ≤ 1 cm, when Ki-67 is ≤5%. Endoscopic submucosal dissection (ESD) increases the risk of duodenal perforation (most often managed endoscopically) but increases complete resection rate. ESD may be considered in some patients if managed in reference centers.
a
With lymph node dissection.
EMR = Endoscopic mucosal resection; NET = neuroendocrine tumors.