Jung Hee Jae, Hong Su Jin, Han Jae Pil, Kim Hyun Su, Jeong Gui-Ae, Cho Gyu-Seok, Kim Hee Kyoung, Ko Bong Min, Lee Moon Sung
Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine.
Department of Surgery, Soonchunhyang University College of Medicine.
J Dig Dis. 2015 Oct;16(10):595-600. doi: 10.1111/1751-2980.12279.
Endoscopic resection (ER) of foregut neuroendocrine tumors (NETs) is increasingly performed instead of surgery. This study aimed to compare the long-term therapeutic outcomes of ER and surgical resection (SR) for foregut NETs.
From 2002 to 2012, a total of 49 patients with histologically confirmed foregut NETs were treated by ER (n = 33) and SR (n = 16). The clinicopathological characteristics and therapeutic outcomes were evaluated.
Of the 33 patients who underwent ER [endoscopic mucosal resection (n = 26), endoscopic mucosal dissection (n = 7)], 32 were diagnosed as NET-G1 and NET-G2, and the other as neuroendocrine carcinoma (NEC). Of the 16 patients who underwent SR, 10 were diagnosed as NET-G1, 2 as NET-G2 and 4 as NEC. The median tumor size was significantly smaller in the ER group compared with the SR group (7 mm vs 19 mm, P = 0.001). In almost all patients treated with ER (32/33), NET invasion was limited to the mucosa and submucosa. Non-curative resections were observed in 24.2% of the patients in the ER group (8/33) and 25.0% in the SR group (4/16). No recurrence occurred in NET cases with positive resection margins by ER. However, all cases of non-curative resection with lymphatic invasion (one in the ER group and four in the SR group) developed liver metastasis during the follow-up despite complete resection, and all these five patients has histologically confirmed NECs.
NET patients treated by ER may have a good prognosis if the tumor size is small and histologically low grade without lymphatic invasion.
前肠神经内分泌肿瘤（NETs）越来越多地采用内镜切除（ER）而非手术治疗。本研究旨在比较前肠NETs的内镜切除（ER）和手术切除（SR）的长期治疗效果。
2002年至2012年，共有49例经组织学确诊的前肠NETs患者接受了ER（n = 33）和SR（n = 16）治疗。评估了临床病理特征和治疗效果。
在接受ER的33例患者中[内镜黏膜切除术（n = 26），内镜黏膜下剥离术（n = 7）]，32例被诊断为NET-G1和NET-G2，另1例为神经内分泌癌（NEC）。在接受SR的16例患者中，10例被诊断为NET-G1，2例为NET-G2，4例为NEC。与SR组相比，ER组的肿瘤中位大小明显更小（7 mm对19 mm，P = 0.001）。几乎所有接受ER治疗的患者（32/33），NET侵犯仅限于黏膜和黏膜下层。ER组24.2%（8/33）的患者和SR组25.0%（4/16）的患者观察到非根治性切除。ER切除边缘阳性的NET病例未发生复发。然而，所有伴有淋巴侵犯的非根治性切除病例（ER组1例，SR组4例）在随访期间均发生肝转移，尽管切除完整，且所有这5例患者经组织学确诊为NEC。
如果肿瘤体积小、组织学分级低且无淋巴侵犯，接受ER治疗的NET患者可能预后良好。
