Endoscopic Versus Surgical Resection of Duodenal Neuroendocrine Neoplasms Between 1 and 2 Cm: a Multi-Centered Retrospective Cohort Study

Introduction Recommendations for resection technique of duodenal neuroendocrine neoplasms (D-NEN) with a size between 1-2 cm are lacking. The primary aim was to compare overall survival (OS) and progression-free survival (PFS) after endoscopic resection (ER) with surgical resection (SR). The secondary aim was to assess the incidence and clinical variables correlated with OS. Methods Data of patients with D-NENs between 2008 and 2018 were extracted from the Netherlands Cancer Registry and the Dutch Nationwide Pathology Databank. Results A total of 259 patients were identified, of which 138 were included: 98 (68%) underwent ER and 44 patients (32%) underwent SR. Of these, 38 patients had D-NENs sized between 1 and 2 cm. ER Patients were more frequently male and had a lower T-stage and tumour size than SR patients (all P<0.05). Positive resection margins were observed more frequently after ER compared to SR (71% vs 15%, P<0.005). No patients with tumours between 1-2 cm died after ER or SR (median follow-up 71.8 vs. 52.0 months). PFS rates were not significantly different after ER compared to SR (P=0.672). Recurrence rates were 13% for ER and 7% for SR (P=0.604). Conclusion Between 2008-2018, the incidence increased from 0.06 to 0.11 per 100,000 patients per year. OS after ER or SR did not differ for D-NEN between 1 and 2 cm. Recurrence and PFS rates were not significantly different. These results suggest that D-NENs sized between 1 and 2 cm could potentially be treated first with ER. Future studies are needed to confirm this hypothesis.