Introduction Duodenal neuroendocrine tumours (d-NETs) are rare, but are increasing in incidence. Current ENETS guidelines advocate resection of all localised d-NETs. However, ‘watch and wait’ may be appropriate for some localised, small, grade 1, non-functioning, non-ampullary d-NETs. We evaluated whether patients with such d-NETs who chose ‘watch and wait’ involving regular endoscopic surveillance had equivalent disease-related outcomes to patients undergoing endoscopic or surgical resection. Methods Retrospective review of patients with histologically confirmed d-NETs at Liverpool ENETS Centre of Excellence 2007-2020. Results Sixty-nine patients were diagnosed with d-NET of which fifty were sporadic, non-functioning, non-ampullary tumours. Patient treatment groups were similar in terms of age, gender, tumour location and grade, but unsurprisingly, larger tumours (median diameter 17mm (p<0.0001)) were found in the surgically treated group. Five patients underwent surgical resection with no evidence of tumour recurrence or disease-related death. Twelve patients underwent endoscopic resection, with one local recurrence detected during follow-up. Thirty patients (28 with d-NETs ≤10mm) underwent ‘watch and wait’ with resection only if tumours increased in size. The d-NETs in 28/30 patients remained stable or decreased in size over a median 27 months (IQR:15-48, R:3-98). In seven patients the d-NET was completely removed by avulsion during diagnostic biopsy and was not seen at subsequent endoscopies. Only two patients showed increased d-NET size during surveillance, of whom only one was fit for endoscopic resection. No NET-related deaths were documented during follow up. Conclusions All of the localised, ≤10mm, grade 1, non-functioning, non-ampullary d-NETs in this cohort behaved indolently with very low risks of progression and no tumour-related deaths. ‘Watch and wait’ therefore appears to be a safe alternative management strategy for selected d-NETs.


中文翻译：

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对于许多患有小型、散发性、1 级、非壶腹、无功能十二指肠神经内分泌肿瘤的患者而言，涉及定期内镜监测的“观察和等待”策略是安全的。

简介 十二指肠神经内分泌肿瘤 (d-NETs) 很少见，但发病率正在增加。当前的 ENETS 指南主张切除所有局部 d-NET。然而，“观察和等待”可能适用于一些局部的、小型的、1 级的、无功能的、非壶腹的 d-NET。我们评估了选择“观察和等待”进行常规内镜监测的此类 d-NET 患者是否与接受内镜或手术切除的患者具有相同的疾病相关结果。方法 2007-2020 年利物浦 ENETS 卓越中心对组织学证实的 d-NET 患者进行回顾性审查。结果 69 例患者被诊断为 d-NET，其中 50 例为散发性、无功能、非壶腹肿瘤。患者治疗组在年龄、性别、肿瘤位置和分级方面相似，但不出所料，在手术治疗组中发现了较大的肿瘤（中位直径 17 毫米（p<0.0001））。五名患者接受了手术切除，没有肿瘤复发或疾病相关死亡的证据。12 例患者接受了内镜下切除术，随访期间发现 1 例局部复发。30 名患者（28 名 d-NET ≤10 毫米）仅在肿瘤增大时才接受“观察和等待”切除术。28/30 名患者的 d-NET 在中位 27 个月内保持稳定或缩小（IQR：15-48，R：3-98）。在 7 名患者中，d-NET 在诊断活检期间被撕脱完全去除，并且在随后的内窥镜检查中未发现。只有两名患者在监测期间显示 d-NET 大小增加，其中只有一名适合内镜切除。随访期间没有记录到与 NET 相关的死亡。结论 该队列中所有局部的、≤10mm、1 级、无功能、无壶腹的 d-NET 表现惰性，进展风险非常低，并且没有与肿瘤相关的死亡。因此，对于选定的 d-NET，“观察和等待”似乎是一种安全的替代管理策略。