Chen Wei-Jie, Wu Nan, Zhou Jiao-Lin, Lin Guo-Le, Qiu Hui-Zhong
Wei-Jie Chen, Nan Wu, Jiao-Lin Zhou, Guo-Le Lin, Hui-Zhong Qiu, Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.
World J Gastroenterol. 2015 Aug 14;21(30):9142-9. doi: 10.3748/wjg.v21.i30.9142.
To assess the efficacy of full-thickness excision using transanal endoscopic microsurgery (TEM) in the treatment of rectal neuroendocrine tumors.
We analyzed the data of all rectal neuroendocrine tumor patients who underwent local full-thickness excision using TEM between December 2006 and December 2014 at our department. Data collected included patient demographics, tumor characteristics, operative details, postoperative outcomes, pathologic findings, and follow-ups.
Full-thickness excision using TEM was performed as a primary excision (n = 38) or as complete surgery after incomplete resection by endoscopic polypectomy (n = 21). The mean size of a primary tumor was 0.96 ± 0.21 cm, and the mean distance of the tumor from the anal verge was 8.4 ± 1.4 cm. The mean duration of the operation was 57.6 ± 13.7 min, and the mean blood loss was 13.5 ± 6.6 mL. No minor morbidities, transient fecal incontinence, or wound dehiscence was found. Histopathologically, all tumors showed typical histology without lymphatic or vessel infiltration, and both deep and lateral surgical margins were completely free of tumors. Among 21 cases of complete surgery after endoscopic polypectomy, 9 were histologically shown to have a residual tumor in the specimens obtained by TEM. No additional radical surgery was performed. No recurrence was noted during the median of 3 years' follow-up.
Full-thickness excision using TEM could be a first surgical option for complete removal of upper small rectal neuroendocrine tumors.
评估经肛门内镜显微手术（TEM）全层切除术治疗直肠神经内分泌肿瘤的疗效。
我们分析了2006年12月至2014年12月在我科接受TEM局部全层切除术的所有直肠神经内分泌肿瘤患者的数据。收集的数据包括患者人口统计学资料、肿瘤特征、手术细节、术后结果、病理检查结果及随访情况。
TEM全层切除术作为初次切除术（n = 38）或在内镜息肉切除不完全切除后作为完整手术（n = 21）进行。原发肿瘤的平均大小为0.96±0.21 cm，肿瘤距肛缘的平均距离为8.4±1.4 cm。平均手术时间为57.6±13.7分钟，平均失血量为13.5±6.6 mL。未发现轻微并发症、短暂性大便失禁或伤口裂开。组织病理学检查显示，所有肿瘤均表现为典型组织学，无淋巴管或血管浸润，手术切缘深部和外侧均无肿瘤残留。在内镜息肉切除术后行完整手术的21例患者中，9例经组织学检查显示TEM获取的标本中有残留肿瘤。未进行额外的根治性手术。在3年的中位随访期内未发现复发。
TEM全层切除术可作为完整切除直肠上段小神经内分泌肿瘤的首选手术方式。
