Evaluating Adenocarcinoma-Based Surgical Paradigms in Gastric Neuroendocrine Tumors: A Comparative Outcomes Analysis.

BackgroundGastric neuroendocrine tumors (gNETs) are rare malignancies with distinct biological behavior compared with gastric adenocarcinoma. Data directly comparing surgical and oncologic outcomes, including lymph node yield, recurrence pattern, and survival, remain limited.MethodsA retrospective review of 285 gastrectomies (2014-2024) identified 20 gNET and 265 adenocarcinoma cases. After excluding palliative procedures and mixed histology, propensity-score matching (1:2.5; age, sex, BMI, and comorbidities) yielded 18 gNET and 45 adenocarcinoma patients. Outcomes included lymph node harvest, nodal metastasis, lymph node ratio (LNR), recurrence pattern, disease-free survival (DFS), and overall survival (OS).ResultsMedian lymph node yield was lower in gNET than in adenocarcinoma (18 vs 28; P = 0.004), and the overall rate of nodal metastasis did not differ between groups (44.4% vs 44.4%; P = 1.00), although the nodal metastatic burden was significantly lower in gNET as reflected by a lower median number of positive nodes and lymph node ratio (LNR 0.05 vs 0.17; P = 0.008), with no gNET patient exhibiting pN3 disease. DFS was comparable (21.4 vs 18.7 months; P = 0.617), whereas OS favored gNET (45.3 vs 27.4 months; P = 0.045). Peritoneal recurrence was markedly less frequent in gNET (16.7% vs 81.3%; P = 0.003), while hepatic relapse predominated. Perioperative morbidity and 90-day mortality were similar.ConclusionCompared with adenocarcinoma, gastric neuroendocrine tumors show reduced nodal metastatic burden, lower peritoneal dissemination, and improved overall survival. These findings support biology-adapted lymphadenectomy and surveillance for gNET, although validation in larger cohorts is required.