Department of Internal Medicine, Division of Gastroenterology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Eur J Gastroenterol Hepatol. 2012 Aug;24(8):978-83. doi: 10.1097/MEG.0b013e3283551e0b.
The endoscopic techniques for treating a small rectal neuroendocrine tumor (NET) are performed in most large centers; however, the endoscopic management of this condition is not well established. This study was designed to determine the long-term prognosis of endoscopically resected NET.
We prospectively studied patients with endoscopically treated rectal NET in Seoul St Mary's hospital, between January 2000 and June 2010. The long-term outcomes were analyzed in association with the pathological complete resection and resection procedures.
Seventy-seven patients (48 men and 29 women; mean age, 52.3 years; range, 23-77 years) were included. The average NET size was 7.0±2.8 mm (range, 3-16 mm). There was no procedure-related complication. En-bloc removal was achieved for all lesions, and the rate of histological complete resection was 75.3% (58/77). Histological complete resection rates were 71.4% (10/14) by conventional endoscopic mucosal resection (EMR), 74.1% (43/58) by a two-channel EMR, and 100.0% (5/5) by endoscopic submucosal dissection (ESD). Among six patients with incomplete histological resection, two underwent additional EMR, two underwent transanal endoscopic microsurgery, and two underwent low anterior section with lymph node dissection. The remaining 13 patients with 'possible' remnant NET underwent regular endoscopic surveillance without additional resection. In the latter group, only one patient had local recurrence, detected on regular colonoscopic surveillance, after 56 months and was treated with additional EMR. All of the patients are alive and 98.7% (76/77) of the patients are free from disease during the follow-up periods.
Endoscopic resection is a safe and effective modality and may potentially be used for the treatment of NETs smaller than 15 mm in diameter, those confined to the submucosal layer, and those without metastasis. Local treatment was believed to be curative in cases with complete histological resection. In addition, this treatment may have an excellent prognosis in patients with 'possible' remnant NET.
大多数大型中心都采用内镜技术治疗小直肠神经内分泌肿瘤（NET）；然而，这种疾病的内镜处理尚未得到很好的确立。本研究旨在确定内镜切除 NET 的长期预后。
我们前瞻性地研究了 2000 年 1 月至 2010 年 6 月期间在首尔圣玛丽医院接受内镜治疗的直肠 NET 患者。分析了与病理完全切除和切除程序相关的长期结果。
共纳入 77 例患者（48 名男性和 29 名女性；平均年龄 52.3 岁；范围 23-77 岁）。NET 平均大小为 7.0±2.8mm（范围 3-16mm）。无手术相关并发症。所有病变均整块切除，组织学完全切除率为 75.3%（58/77）。常规内镜黏膜切除术（EMR）的组织学完全切除率为 71.4%（10/14），双通道 EMR 为 74.1%（43/58），内镜黏膜下剥离术（ESD）为 100.0%（5/5）。在 6 例组织学不完全切除的患者中，2 例行追加 EMR，2 例行经肛门内镜显微手术，2 例行低位前切除术和淋巴结清扫术。其余 13 例“可能”残留 NET 患者定期行内镜监测，未行额外切除。在后一组中，仅 1 例患者在 56 个月后在常规结肠镜监测中发现局部复发，行追加 EMR 治疗。所有患者均存活，77 例患者中有 98.7%（76/77）在随访期间无疾病。
内镜切除是一种安全有效的治疗方法，可能适用于直径小于 15mm、局限于黏膜下层且无转移的 NET。在组织学完全切除的情况下，局部治疗被认为是治愈性的。此外，在“可能”残留 NET 患者中，这种治疗方法可能具有极好的预后。
