Gastric carcinoid tumors are borderline areas , treatment principles should be the same cancer, once diagnosed should be early surgery. Surgical options should be based on the degree of differentiation , single or multiple , tumor size, invasive range , depending on the biological behavior . Commonly used methods are:
1 , endoscopic electrocautery resection of gastric carcinoid type Ⅰ mostly benign biological behavior , little progress can even disappear on their own . Therefore, chronic atrophic gastritis associated with multi-center small ( only a few millimeters ) carcinoid , repeated gastroscopy can. Ⅰ diameter 1.0 ~ 1.5cm gastric carcinoid tumors can be down- endoscopic electrocautery resection . 1 ~ 2cm in diameter who are low-grade , histological examination if no stomach can travel deep infiltration electrocautery resection. Endoscopic resection of other types of gastric carcinoid single 1cm should be limited to the following , regardless of whether the merger MEN-Ⅰ or ZES. Regular monitoring of postoperative follow-up endoscopy stressed , to prevent recurrence.
2 , gastric resection hypergastrinemia can cause ECL cell proliferation and formation of carcinoid tumors , gastric resection can increase gastrin to normal, reducing the risk of tumor progression . Hirschowitz reported three cases of pernicious anemia , the patient multi-center hypergastrinemia and gastric carcinoid tumors , gastric resection serum gastrin levels were reduced to normal plasma . Postoperative follow-up endoscopy with biopsy from 12 to 18 months foci were seen micro class , 21 to 30 months biopsy carcinoid and ECL cell hyperplasia disappeared completely. Although serum gastrin levels returned to normal , and gastric carcinoid further development of multiple 23 months after surgery still . Thus , gastric resection apply early lesions , larger lesions associated with primary nodular hyperplasia should do the whole stomach or subtotal resection. After regular follow-up endoscopy .
3 , partial resection of gastric carcinoid apply this surgical lesion diameter less than 2cm, has not yet invaded the serosa without lymph node metastasis , tumor margin can be from 2 ~ 3cm local excision .
4 palliative gastrectomy gastric malignant carcinoid tumors occur when multiple liver metastases , resection of the primary lesion still .
5 radical gastrectomy and total gastrectomy applicable to tumor diameter 2cm, serosal invasion or regional lymph node metastasis were poorly differentiated or undifferentiated , or diffuse lesions , multiple . Gastrinoma combined fatal ulcers, exploration did not find the primary lesion , is also feasible total gastrectomy .
Christopher made the diagnosis and treatment of gastric carcinoid mode , and the number of lesions less than 1cm less than 3 to 5 of Ⅰ and type Ⅱ gastric carcinoid feasible endoscopic polypectomy , after every six months later a second endoscopy, if recurrence is OK antrum resection or partial resection. And the number of lesions greater than 1cm more than five of Ⅰ and type Ⅱ antral gastric carcinoid tumor resection or partial row resection, every six months later a second endoscopy, if the row relapse total gastrectomy . Ⅲ gastric carcinoid tumors often have regional lymph nodes or liver metastasis , radical gastrectomy should be OK .
Surgical exploration of the liver must , watch for metastases. Limitations on liver metastasis , depending on the circumstances row metastases resection, liver resection or semi- lobe , while multiple lesions or lesions huge unresectable , could try hepatic arterial chemotherapy , chemotherapy pump subcutaneously , liver artery ligation or transcatheter arterial embolization , cryotherapy, to alleviate the suffering of patients and prolong survival time. Preoperative application of somatostatin analogues can prevent the occurrence of carcinoid crisis .
Gastric carcinoid tumors generally grow slowly, longer survival time after diagnosis in patients with gastric carcinoid overall 5-year survival rate of approximately 52 %. Prognosis depends on the histologic features of lesions , pathological type, whether distant metastasis , surgical resection of general scope and severity of clinical symptoms in patients . Metastasis , atypical histology , serosal invasion and tumors larger than 2cm are poor prognostic indicators. Lesions confined to 5-year survival rate is about 90% , local metastasis approximately 23% 5-year survival , distant metastasis , tumor , and have a poor prognosis carcinoid syndrome , multiple die within two years. Race , gender and age had no obvious effect on survival.