GASTRIC NEUROENDOCRINE TUMOR: WHEN SURGICAL TREATMENT IS INDICATED?

BACKGROUND: Gastric neuroendocrine tumors are a heterogeneous group of neoplasms that produce bioactive substances. Their treatment varies according to staging and classification, using endoscopic techniques, open surgery, chemotherapy, radiotherapy, and drugs analogous to somatostatin. AIMS: To identify and review cases of gastric neuroendocrine neoplasia submitted to surgical treatment. METHODS: Review of surgically treated patients from 1983 to 2018. RESULTS: Fifteen patients were included, predominantly female (73.33%), with a mean age of 55.93 years. The most common symptom was epigastric pain (93.3%), and the mean time of symptom onset was 10.07 months. The preoperative upper digestive endoscopy (UDE) indicated a predominance of cases with 0 to 1 lesion (60%), sizing ≥1.5 cm (40%), located in the gastric antrum (53.33%), with ulceration (60%), and Borrmann III (33.33%) classification. The assessment of the surgical specimen indicated a predominance of invasive neuroendocrine tumors (60%), with angiolymphatic invasion in most cases (80%). Immunohistochemistry for chromogranin A was positive in 60% of cases and for synaptophysin in 66.7%, with a predominant Ki-67 index between 0 and 2%. Metastasis was observed in 20% of patients. The surgical procedure most performed was subtotal gastrectomy with Roux-en-Y reconstruction (53.3%). Tumor recurrence occurred in 20% of cases and a new treatment was required in 26.67%. CONCLUSIONS: Gastric neuroendocrine tumors have a low incidence in the general population, and surgical treatment is indicated for advanced lesions. The study of its management gains importance in view of the specificities of each case and the need for adequate conduct to prevent recurrences and complications.

Gastric neuroendocrine tumor: when surgical treatment is indicated? / Tumor neuroendócrino gástrico: quando tratamento cirúrgico está indicado?

ABSTRACT BACKGROUND: Gastric neuroendocrine tumors are a heterogeneous group of neoplasms that produce bioactive substances. Their treatment varies according to staging and classification, using endoscopic techniques, open surgery, chemotherapy, radiotherapy, and drugs analogous to somatostatin. AIMS: To identify and review cases of gastric neuroendocrine neoplasia submitted to surgical treatment. METHODS: Review of surgically treated patients from 1983 to 2018. RESULTS: Fifteen patients were included, predominantly female (73.33%), with a mean age of 55.93 years. The most common symptom was epigastric pain (93.3%), and the mean time of symptom onset was 10.07 months. The preoperative upper digestive endoscopy (UDE) indicated a predominance of cases with 0 to 1 lesion (60%), sizing ≥1.5 cm (40%), located in the gastric antrum (53.33%), with ulceration (60%), and Borrmann III (33.33%) classification. The assessment of the surgical specimen indicated a predominance of invasive neuroendocrine tumors (60%), with angiolymphatic invasion in most cases (80%). Immunohistochemistry for chromogranin A was positive in 60% of cases and for synaptophysin in 66.7%, with a predominant Ki-67 index between 0 and 2%. Metastasis was observed in 20% of patients. The surgical procedure most performed was subtotal gastrectomy with Roux-en-Y reconstruction (53.3%). Tumor recurrence occurred in 20% of cases and a new treatment was required in 26.67%. CONCLUSIONS: Gastric neuroendocrine tumors have a low incidence in the general population, and surgical treatment is indicated for advanced lesions. The study of its management gains importance in view of the specificities of each case and the need for adequate conduct to prevent recurrences and complications.

RESUMO RACIONAL: Os tumores neuroendócrinos gástricos são um grupo heterogêneo de neoplasias produtoras de substâncias bioativas, sendo o seu tratamento variável de acordo com o estadiamento e a classificação, sendo utilizadas técnicas endoscópicas, cirurgias abertas, quimioterapia, radioterapia e fármacos análogos da somatostatina. OBJETIVOS: Identificar e revisar os casos de neoplasia neuroendócrina gástrica submetidos a tratamento cirúrgico. MÉTODOS: Revisão os doentes tratados cirurgicamente de 1983 e 2018. RESULTADOS: Foram incluídos 15 pacientes, com predomínio do sexo feminino (73,33%) e média de idade de 55,93 anos. O sintoma mais comum foi a epigastralgia (93,3%) e o tempo médio do início dos sintomas foi de 10,07 meses. A endoscopia digestiva pré-operatória indicou predomínio de casos com 0 a 1 lesões (60%), de tamanho ≥ 1,5 cm (40%), localizadas em antro gástrico (53,33%), com ulceração (60%), Borrmann 3 (33,33%). A avaliação da peça cirúrgica indicou um predomínio de tumores neuroendócrinos invasivos (60%), com invasão angiolinfática na maioria dos casos (80%). A imuno-histoquímica para cromogranina A foi positiva em 60% dos casos e para sinaptofisina em 66,7%, com índice de Ki-67 predominante entre 0 e 2%. Metástases foram observadas em 20% dos casos. O procedimento cirúrgico mais utilizado foi a gastrectomia subtotal com reconstrução em Y de Roux (53,3%). Recidiva tumoral ocorreu em 20% dos casos e novo tratamento foi necessário em 26,67% dos casos. CONCLUSÕES: Os tumores neuroendócrinos gástricos apresentam baixa incidência na população em geral, e o tratamento cirúrgico está indicado nas lesões avançadas. O estudo de seu manejo ganha importância frente às especificidades de cada caso e a necessidade de conduta adequada para a prevenção de recidivas e complicações.