在筛查性结肠镜检查中，与先进的内镜切除相比，通过单纯切除性活检切除的小的偶然发现的直肠神经内分泌肿瘤的长期结果。

Long-term Outcome of Small, Incidentally Detected Rectal Neuroendocrine Tumors Removed by Simple Excisional Biopsy Compared With the Advanced Endoscopic Resection During Screening Colonoscopy.

机构信息

Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.

Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.

出版信息

Dis Colon Rectum. 2018 Mar;61(3):338-346. doi: 10.1097/DCR.0000000000000905.

DOI:10.1097/DCR.0000000000000905

PMID:29369898

Abstract

BACKGROUND

Incidental, small rectal neuroendocrine tumors during colonoscopy screening are sometimes removed using biopsy forceps. Few studies have examined the clinical course of rectal neuroendocrine tumors removed by simple excisional biopsy.

OBJECTIVE

We investigated the long-term outcome of rectal neuroendocrine tumors removed by simple excisional biopsy compared with standard endoscopic resection.

DESIGN

This was a cohort study.

SETTINGS

This study was performed at a healthcare center in Korea.

PATIENTS

We enrolled patients with rectal neuroendocrine tumors detected during a screening colonoscopy between 2003 and 2015.

MAIN OUTCOME MEASURES

The clinical characteristics and long-term outcomes (overall survival and disease-free survival) of small neuroendocrine tumors <10 mm were compared between the simple excisional biopsy group and advanced endoscopic resection group.

RESULTS

In total, 166 patients were diagnosed with rectal neuroendocrine tumors (≤5 mm, n = 100; 6-9 mm, n = 50; 10-19 mm, n = 15; ≥20 mm, n = 1). Among the 150 patients with neuroendocrine tumors <10 mm, follow-up endoscopy was performed on 99 (59.6%). All of the tumors were confined to the mucosa or submucosa. Thirty-one and 68 patients were included in the simple excisional biopsy and advanced endoscopic resection groups. The overall follow-up duration was 6.5 years (range, 1.0-12.8 y). Neither overall nor disease-related death occurred. Two patients exhibited local recurrence (6.5%, at 8 and 11 y) in the simple excisional biopsy group and 1 patient (1.5%, at 7 y) in the advanced endoscopic resection group, resulting in no significant difference (p = 0.37). All of the recurrences were diagnosed >5 years from initial diagnosis and successfully treated endoscopically.

LIMITATIONS

More long-term data should be warranted.

CONCLUSIONS

The long-term outcome of small rectal neuroendocrine tumors <10 mm removed by simple excisional biopsy was excellent. Neither overall survival nor disease-free survival significantly differed between the simple excisional biopsy group and the advanced endoscopic resection group. Thus, simple excisional biopsy and long-term follow-up can be cautiously applied for small rectal neuroendocrine tumors in clinical practice. See Video Abstract at http://links.lww.com/DCR/A406.

摘要

背景

在结肠镜筛查期间偶然发现的小直肠神经内分泌肿瘤，有时使用活检钳切除。很少有研究检查过单纯切除活检切除的直肠神经内分泌肿瘤的临床过程。

目的

我们研究了与标准内镜切除相比，单纯切除活检切除直肠神经内分泌肿瘤的长期结果。

设计

这是一项队列研究。

设置

本研究在韩国的一个医疗中心进行。

患者

我们招募了 2003 年至 2015 年间在筛查结肠镜检查中发现的直肠神经内分泌肿瘤患者。

主要观察指标

比较单纯切除活检组和高级内镜切除组小神经内分泌肿瘤(<10mm)的临床特征和长期结果(总生存率和无病生存率)。

结果

共有 166 例患者被诊断为直肠神经内分泌肿瘤(≤5mm，n=100;6-9mm，n=50;10-19mm，n=15;≥20mm，n=1)。在 150 例<10mm 的神经内分泌肿瘤患者中，99 例(59.6%)进行了随访内镜检查。所有肿瘤均局限于黏膜或黏膜下层。31 例和 68 例患者分别纳入单纯切除活检组和高级内镜切除组。总的随访时间为 6.5 年(范围，1.0-12.8y)。单纯切除活检组无总生存和疾病相关死亡，高级内镜切除组有 1 例(1.5%，在 7 年时)发生局部复发，差异无统计学意义(p=0.37)。所有复发均在初始诊断后>5 年诊断，并成功行内镜治疗。