The validity of current guidelines regarding surgical management of patients with gastric neuroendocrine neoplasms type 1: a report of a series of seven patients

OBJECTIVE: Gastric neuroendocrine neoplasms Type 1 (GEN type 1) are mostly localized indolent tumors, with only a minority developing lymph node or distant metastasis. Although they are usually managed conservatively, large, invasive, recurrent and grade 2 lesions may require surgical treatment. The aim of this case series is to evaluate the validity of current guidelines regarding surgical management of patients with GEN type 1. CASES: Seven patients (5 female) with GEN type 1 underwent peri-gastric lymphadenectomy when at least one of the following criteria employed in previous guidelines was present: (i) multiple recurrent lesions, (ii) lesions with positive margins following endoscopic resection, (iii) lesions with malignant potential (deep gastric parietal wall invasion, lymph node enlargement, Ki67 proliferative index >2%), or (iv) presence of metastatic disease. Four patients met one and three two of the previously defined criteria; fifteen to thirty-six peri-gastric lymph nodes were resected. Following surgery there was no alteration in tumor staging status compared to pre-surgical staging. During a median follow-up of 34 months, all patients remain without any evidence of disease recurrence. CONCLUSION: Peri-gastric lymphadenectomy did not prove to be necessary for localized GEN type 1, neither for staging nor for therapeutical reasons. Further parameters need to be evaluated to identify the small subset of patients that will develop more aggressive disease.