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Am J Surg. 2019 May;217(5):937-942. doi: 10.1016/j.amjsurg.2018.12.057. Epub 2018 Dec 28.

Gastric carcinoids: Does type of surgery or tumor affect survival?

Author information

1
Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
2
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
3
Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
4
Department of Surgery, Stanford University Medical Center, Stanford, CA, USA.
5
Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
6
Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
7
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
8
Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.
9
Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA. Electronic address: flavio.rocha@virginiamason.org.

Abstract

BACKGROUND:

Gastric carcinoids are rare neuroendocrine tumors of the gastrointestinal tract. They are typically managed according to their etiology. However, there is little known about the impact of surgical strategy on the long-term outcomes of these patients.

METHODS:

All patients who underwent resection of gastric carcinoids at 8 institutions from 2000 to 2016 were analyzed retrospectively. Tumors were stratified according to subtype (I, II, III, IV) and resection type (local resection, LR or formal gastrectomy, FG). Clinicopathological parameters, recurrence-free (RFS) and overall survival (OS) were compared between groups.

RESULTS:

Of 79 patients identified with gastric carcinoids, 34 had type I lesions associated with atrophic gastritis, 4 had type II lesions associated with a gastrinoma, 37 had type III sporadic lesions, and 4 had type IV poorly-differentiated lesions. The mean age of presentation was 56 years in predominantly Caucasian (77%) and female (63%) patients. Mean tumor size was 2.4 cm and multifocal tumors were found in 24 (30%) of patients with the majority occurring in those with type I tumors. Lymph node positive tumors were seen in 15 (19%) patients and 7 (8%) had M1 disease; both most often in type IV followed by type III tumors. R0 resection was achieved in 56 (71%) patients while 15 (19%) had R1 resections and 6 (8%) R2 resections. Patients with type I and III tumors were equally likely to have a LR (50% and 43% respectively) compared to FG while those with type II and IV all had FG with one exception. Type IV tumors had the poorest RFS and OS while Type II tumors had the most favorable RFS and OS (p < 0.04 and p < 0.0004, respectively). While there was no difference in RFS in those patients undergoing FG versus LR, OS was worse in the FG group (p < 0.017). This trend persisted when type II and type IV groups were excluded (p < 0.045).

CONCLUSION:

Gastric carcinoid treatment should be tailored to tumor type, as biologic behavior rather than resection technique is the more important factor contributing to long-term outcomes.

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