Defining Surgical Indications for Type I Gastric Carcinoid Tumor

Most gastric carcinoid tumors (GC) (type I) occur in association with achlorhydria, hypergastrinemia, atrophic gastritis and exhibit low-grade histopathology. The management of this indolent disease is controversial. The aim of this study was to evaluate endoscopic surveillance (ES) compare with surgical resection (SR) for type I GC. Between 1985 and 2007, 65 patients with type I GC were identified. Data analysis included: demographics, biochemical and endoscopic assessment, type of operation performed, and pathologic evaluation. The primary endpoints were disease-specific survival (DSS) in both groups and recurrence-free survival (RFS) in SR patients. Median follow-up was 30 months (range 1-176 months); most patients were female (83%) with median age of 58 years (range 29-91 years). Type I GC was diagnosed by evidence of hypergastrinemia and/or positive autoimmune antibodies with histopathologic confirmation. Patients underwent ES with polypectomy (n = 46) or gastric resection (n = 19). SR was performed with larger tumor size, increased depth of invasion, and solitary tumors. Although the 5-year RFS in SR patients was 75%, the DSS in both groups was 100%. However, concomitant adenocarcinoma was identified in 4/19 resected cases; 2/4 were detected on preoperative biopsies. All cases with coexisting gastric adenocarcinoma had larger carcinoid tumors and more advanced carcinoid disease. The DSS is excellent for type I GC patients treated with either ES or SR. SR should be considered with more advanced carcinoid disease given its association with an increased risk of adenocarcinoma. ES is appropriate to assess both the status of carcinoid disease and dysplasia or adenocarcinoma that can develop in association with type I GC.