Abstract
BackgroundType I gastric neuroendocrine tumors (GNETs) originate from hyperplasia of enterochromaffinlike (ECL) cells and are commonly detected in patients with chronic atrophic gastritis, including autoimmune gastritis. Typical treatment for type I GNETs comprises simple surveillance and/or endoscopic resection. For alleviation of hypergastrinemia resulting in ECL cell hypertrophy, antrectomy is a treatment option. Type I GNETs mostly have excellent prognosis, and if a surgical approach is chosen, the procedure must be minimally invasive. One such technique for multiple type I GNETs, minimally invasive single-incision laparoscopic antrectomy (SILA), is reported here for the first time.Case presentationWe performed SILA on a 46-year-old woman who developed type I GNETs caused by hypergastrinemia due to autoimmune gastritis. A Lap-Protector was inserted in a 3 cm incision at the umbilicus, and set an EZ Access equipped with two 5 mm trocars and one 12 mm trocar. Antrectomy without lymph node dissection was performed using a 5 mm forward-oblique viewing endoscope, a vessel sealing device, and linear staplers, while reconstruction was by Billroth I reconstruction. Side-to-side anastomosis was performed using a 45 mm linear stapler. The stapler entry hole was sutured intracorporeally using barbed suture material. The operation time was 140 min and blood loss was 5 ml. The patient was discharged ten days after surgery without complications. Serum gastrin level decreased to within the normal range on the day after the operation. One year after surgery, esophagogastroduodenoscopy showed pathological disappearance of all lesions of the remnant stomach.ConclusionsSILA is a minimally-invasive and tolerable technique for treatment of multiple type I GNETs. In this reported case there was good cohesiveness and effectiveness in normalizing gastrin levels and in elimination of remnant gastric lesions.
Highlights
Type I gastric neuroendocrine tumors (GNETs) originate from hyperplasia of enterochromaffinlike (ECL) cells and are commonly detected in patients with chronic atrophic gastritis, including autoimmune gastritis
We propose that laparoscopic surgery, especially single-incision laparoscopic surgery (SILS), may be suitable for the treatment of type I GNETs, which is seen predominantly in young patients
Type I GNETs are known to be associated with other autoimmune endocrine disorders, such as Hashimoto’s thyroiditis, premature ovarian failure, vitiligo, and diabetes mellitus type 1, as well as autoimmune gastritis [9]
Summary
Neuroendocrine tumors (NETs) are rare neoplasms that arise from the peripheral neuroendocrine system and are dispersed in various organs [1]. Type III GNETs comprise 10− 15% of gastric NETs; they are sporadic tumors that develop independently from gastrin secretion. They include NET G3 and neuroendocrine carcinoma (NEC), with a metastasis risk above 50%. Regarding treatments of Type I GNETs, the National Comprehensive Cancer Network (NCCN) guidelines recommend simple surveillance or endoscopic resection for tumors < 20 mm in size and without features of invasion of muscularis propria or metastasis, regardless of the number of tumors [4] Antrectomy is another treatment option for younger patients and cases for whom frequent follow-up endoscopy would be difficult. Antrectomy without lymph node dissection was performed using a 5 mm 30° forward-oblique viewing endoscope, a vessel sealing
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