Kim Hyoung Ran, Lee Woo Yong, Jung Kyung Uk, Chung Hyuk Jun, Kim Chul Joong, Yun Hae-Ran, Cho Yong Beom, Yun Seong Hyeon, Kim Hee Cheol, Chun Ho-Kyung
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Korean Soc Coloproctol. 2012 Aug;28(4):201-4. doi: 10.3393/jksc.2012.28.4.201. Epub 2012 Aug 31.
Recently, an increase in well-differentiated rectal neuroendocrine tumors (WRNETs) has been noted. We aimed to evaluate transanal endoscopic microsurgery (TEM) for the treatment of WRNETs.
Between December 1995 and August 2009, 109 patients with WRNETs underwent TEM. TEM was performed for patients with tumors sizes of up to 20 mm and without a lymphadenopathy. These patients had been referred from other clinics after having been diagnosed with WRNETs by using a colonoscopic biopsy; they had undergone a failed endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) and exhibited an involved resection margin and remaining tumor after ESD or EMR, regardless of the distance from the anal verge. This study included 38 patients that had more than three years of follow-up.
The mean age of the patients was 51.3 ± 11.9 years, the mean tumor size was 8.0 ± 3.9 mm, and no morbidity occurred. Thirty-five patients were asymptomatic. TEM was performed after a colonoscopic resection in 13 cases because of a positive resection margin, a residual tumor or a non-lifting lesion. Complete resections were performed in 37 patients; one patient with a positive margin was considered surgically complete. In one patient, liver metastasis and a recurrent mesorectal node occurred after five and 10 years, respectively.
TEM might provide an accessible and effective treatment either as an initial or as an adjunct after a colonoscopic resection for a WRNET.
最近，已注意到高分化直肠神经内分泌肿瘤（WRNETs）的发病率有所增加。我们旨在评估经肛门内镜显微手术（TEM）治疗WRNETs的效果。
1995年12月至2009年8月期间，109例WRNETs患者接受了TEM治疗。对肿瘤大小达20mm且无淋巴结病的患者进行TEM。这些患者在经结肠镜活检诊断为WRNETs后从其他诊所转诊而来；他们接受内镜黏膜下剥离术（ESD）或内镜黏膜切除术（EMR）失败，且无论距肛缘距离如何，ESD或EMR后均显示切缘受累及残留肿瘤。本研究纳入了38例随访超过三年的患者。
患者的平均年龄为51.3±11.9岁，平均肿瘤大小为8.0±3.9mm，未发生并发症。35例患者无症状。13例患者因切缘阳性、残留肿瘤或非抬举性病变在结肠镜切除术后接受了TEM。37例患者实现了完整切除；1例切缘阳性患者被认为手术完整。1例患者分别在5年和10年后发生肝转移和直肠系膜淋巴结复发。
TEM作为WRNET的初始治疗或结肠镜切除术后的辅助治疗可能是一种可行且有效的治疗方法。
