Kim Jihye, Kim Jee Hyun, Lee Joo Young, Chun Jaeyoung, Im Jong Pil, Kim Joo Sung
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Republic of Korea.
Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, 07061, Republic of Korea.
BMC Gastroenterol. 2018 Jun 5;18(1):77. doi: 10.1186/s12876-018-0806-y.
The incidence of rectal neuroendocrine tumors (NETs) is rapidly increasing because of the frequent use of endoscopic screening for colorectal cancers. However, the clinical outcomes of endoscopic resection for rectal NETs are still unclear. The aim of this study was to assess the rates of histologically complete resection (H-CR) and recurrence after endoscopic mucosal resection (EMR) for rectal NETs.
A retrospective analysis was performed on patients who underwent EMR for rectal NETs between January 2002 and March 2015 at Seoul National University Hospital. Primary outcomes were H-CR and recurrence rates after endoscopic resection. H-CR was defined as the absence of tumor invasion in the lateral and deep margins of resected specimens.
Among 277 patients, 243 (88%) were treated with conventional EMR, 23 (8%) with EMR using a dual-channel endoscope, and 11 (4%) with EMR after precutting. The median tumor size was 4.96 mm (range, 1-22) in diameter, and 264 (95%) lesions were confined to the mucosa and submucosal layer. The en-bloc resection rate was 99% and all patients achieved endoscopically complete resection. The H-CR rates were 75, 74, and 73% for conventional EMR, EMR using a dual-channel endoscope, and EMR after precutting, respectively. Multivariate analysis showed that H-CR was associated with tumor size regardless of endoscopic treatment modalities (p = 0.023). Of the 277 patients, 183 (66%) underwent at least 1 endoscopic follow-up. Three (2%) of these 183 patients had tumor recurrence, which was diagnosed at a median of 62.5 months (range 19-98) after endoscopic resection. There was 1 case of disease-related death, which occurred 167 months after endoscopic treatment because of bone marrow failure that resulted from tumor metastasis.
Although the en-bloc resection rate was 99% in rectal NETs, H-CR rates were 72-74% for various EMR procedures. H-CR may be associated with tumor size regardless of endoscopic treatment modalities.
由于结直肠癌内镜筛查的频繁使用，直肠神经内分泌肿瘤（NETs）的发病率正在迅速上升。然而，直肠NETs内镜切除的临床结果仍不明确。本研究的目的是评估直肠NETs内镜黏膜切除术（EMR）后组织学完全切除（H-CR）率和复发率。
对2002年1月至2015年3月在首尔国立大学医院接受直肠NETs EMR的患者进行回顾性分析。主要结局是内镜切除后的H-CR率和复发率。H-CR定义为切除标本的侧切缘和深切缘无肿瘤浸润。
277例患者中，243例（88%）接受传统EMR治疗，23例（8%）接受双通道内镜EMR治疗，11例（4%）接受预切开后EMR治疗。肿瘤中位直径为4.96mm（范围1-22），264例（95%）病变局限于黏膜和黏膜下层。整块切除率为99%，所有患者均实现内镜下完全切除。传统EMR、双通道内镜EMR和预切开后EMR的H-CR率分别为75%、74%和73%。多变量分析显示，无论内镜治疗方式如何，H-CR均与肿瘤大小相关（p = 0.023）。277例患者中，183例（66%）至少接受了1次内镜随访。这183例患者中有3例（2%）出现肿瘤复发，中位复发时间为内镜切除后62.5个月（范围19-98）。有1例与疾病相关的死亡，发生在内镜治疗后167个月，原因是肿瘤转移导致的骨髓衰竭。
尽管直肠NETs的整块切除率为99%，但各种EMR手术的H-CR率为72%-74%。无论内镜治疗方式如何，H-CR可能与肿瘤大小相关。
