Clinical Outcomes of Antrectomy for Patients With Multiple Type I Gastric Neuroendocrine Tumors: A Case Series.
Antrectomy in patients with multiple type I gastric neuroendocrine tumors resulted in decreased serum gastrin levels and tumor regression in all cases, but findings are based on a small sample size.
Where it sits
this study against the rest of the teriparatide (pth 1-34) corpusSummary and findings
This study evaluated the clinical outcomes of antrectomy in eight patients with multiple type I gastric neuroendocrine tumors (T1-GNETs). The median preoperative serum gastrin level was 4800 pg/mL, which decreased to 68 pg/mL postoperatively. Tumor regression or disappearance was observed in all cases during a median follow-up of 56 months.
Abstract
<h4>Objectives</h4>Type I gastric neuroendocrine tumors (T1-GNETs) are frequently associated with autoimmune gastritis and typically present as multiple lesions. The treatment options for T1-GNETs include endoscopic resection (ER), surgical resection, and pharmaceutical therapies. Antrectomy is reportedly an effective treatment for multiple T1-GNETs; however, its efficacy and indication remain unclear. In this study, we aimed to assess the efficacy of antrectomy in patients with multiple T1-GNETs.<h4>Methods</h4>We retrospectively evaluated the clinical outcomes of eight patients with persistent multiple T1-GNETs in the gastric remnant following antrectomy from 2005 to 2023.<h4>Results</h4>All eight patients (median age: 60 years, male-to-female ratio 1:3) had body-dominant atrophic gastritis. Median preoperative serum gastrin levels were 4800 (range, 2400-11,000) pg/mL. Preoperative endoscopy revealed <10 in two, 10-20 in one, and >20 in five patients. Antrectomy was performed as a primary surgery in three patients, as a completion surgery following non-curative ER in two patients, and a combination therapy with pre-antrectomy ER in three patients. Median serum gastrin levels decreased to 68 (range, 25-120) pg/mL during the median followup of 56 (range, 14-72 months). Tumor regression was observed in two patients and disappearance in six, with no recurrence or deaths.<h4>Conclusion</h4>We assessed the residual T1‑GNETs post-antrectomy and discovered either regression or disappearance in all cases. Normalized serum gastrin levels following antrectomy may have contributed to this outcome. On the basis of our findings, the combination of antrectomy and ER resulted in tumor regression that may represent a potential organ-preserving approach for patients with multiple T1-GNETs.
Background
This paper addresses the clinical efficacy of antrectomy for patients with multiple type I gastric neuroendocrine tumors (T1-GNETs), which are often associated with autoimmune gastritis. Prior knowledge indicates that treatment options include endoscopic resection, surgical resection, and pharmaceutical therapies, but the effectiveness of antrectomy remains uncertain. This study is significant as it aims to clarify the outcomes of antrectomy in this specific patient population.
Methods
The study employed a retrospective design, evaluating eight patients with persistent multiple T1-GNETs following antrectomy from 2005 to 2023. The median age of patients was 60 years, with a male-to-female ratio of 1:3. Antrectomy was performed either as a primary surgery, completion surgery following non-curative endoscopic resection, or in combination with pre-antrectomy endoscopic resection. The primary outcome measure was the change in serum gastrin levels, while secondary outcomes included tumor regression and overall survival.
Results
The median preoperative serum gastrin level was 4800 (range, 2400-11,000) pg/mL. Following antrectomy, the median serum gastrin levels decreased to 68 (range, 25-120) pg/mL during a median follow-up of 56 (range, 14-72 months). Tumor regression was noted in two patients, while six experienced complete disappearance of tumors. No recurrence or deaths were reported during the follow-up period.
Interpretation
The findings suggest that antrectomy may lead to significant reductions in serum gastrin levels and tumor regression in patients with T1-GNETs. However, the clinical significance of these results is uncertain due to the small sample size and lack of a control group. Previous literature has shown variable outcomes with different treatment modalities for T1-GNETs, and the absence of recurrence or deaths in this small cohort does not establish a definitive conclusion about the efficacy of antrectomy in broader populations.
Key findings
- Median preoperative serum gastrin levels were 4800 (range, 2400-11,000) pg/mL.
- Median serum gastrin levels decreased to 68 (range, 25-120) pg/mL during the median follow-up of 56 (range, 14-72 months).
- Tumor regression was observed in two patients and disappearance in six.
- No recurrence or deaths were reported.
Limitations
- small n=8 retrospective study
- no control group for comparison
- short follow-up range of 14-72 months
- not applicable for broader populations