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Aim: To describe a single center's experience with treatment of duodenal and periampullary carcinoid tumors.
Methods: This is a descriptive, retrospective review of 40 patients treated for duodenal and periampullary carcinoid. Clinical findings, operative treatment, pathologic staging, and recurrence rates were assessed.
Results: 40 patients underwent 45 interventions for duodenal or periampullary carcinoid tumors between 1990 and 2007. Mean follow-up was 44 months. Results are summarized in Table 1. Interventions included endoscopic resection (either forceps biopsy or endoscopic mucosal resection), transduodenal local excision (either laparoscopic or open), segmental duodenal resection (with or without antrectomy), pancreaticoduodenectomy, and double bypass for unresectable disease. Recurrence was most common in the endoscopic resection patients (n=5), all treated successfully with either repeat endoscopic or surgical therapy. Two patients in the other groups experienced recurrent disease, both metastatic disease to the liver. 5 patients died; two died due to metastatic carcinoid tumor; the other three died of causes unrelated to carcinoid. Neither recurrence nor survival correlated with size of the original lesion or presence of positive lymph nodes.
Conclusion: Excellent recurrence free and overall survival is enjoyed by patients with duodenal and periampullary carcinoid tumors. Selection of the appropriate resection strategy is largely based on location and technical considerations. More extensive resection is associated with higher detection of positive lymph nodes, but does not conclusively provide oncologic benefit.

Table 1.

Therapy	n	Duodenal	Peri-ampullary	Mean size	Node positive	Recurr.	Death
Endoscopic resection	18	17	1	1.1 cm	0	5	2
Transduod. local excision	15	12	3	0.9 cm	2	1	0
Segmental resection	5	5	0	4.0 cm	1	0	1
Whipple	6	0	6	1.5 cm	3	1	1
Palliative procedure	1	1	0	4.0 cm	1	0	1
TOTAL	45	35	10	1.5 cm	7	7	5

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