Fujimoto Ai, Sasaki Motoki, Goto Osamu, Maehata Tadateru, Ochiai Yasutoshi, Kato Motohiko, Nakayama Atsushi, Akimoto Teppei, Kuramoto Jyunko, Hayashi Yuichiro, Kameyama Kaori, Yahagi Naohisa
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Japan.
Department of Diagnostic Pathology, Keio University Hospital, Japan.
Intern Med. 2019 Mar 15;58(6):773-777. doi: 10.2169/internalmedicine.1517-18. Epub 2018 Nov 19.
Objective The vertical margin of neuroendocrine tumors (NETs) removed by endoscopic mucosal resection (EMR) is often tumor-positive. We examine the treatment results of endoscopic mucosal resection with a ligation device (EMR-L) for the removal of duodenal NETs located in the submucosal layer without metastasis. EMR-L can be performed with less technical skill, and the ligation device reduces the rate of positive vertical margin. Methods Ten consecutive patients with 10 duodenal NETs resected by EMR-L were enrolled. All of the lesions were located in the submucosal layer, were assessed to be free of metastasis, and were confirmed to be NETs pathologically by an endoscopic biopsy. The endoscopic results, pathological results, and prognosis were all examined. Results The en bloc resection rate and endoscopic complete resection rate were both 100%. Complete resection was achieved pathologically in 7 lesions (70.0%). The vertical margins were negative in all cases. Lymphatic vessel invasion was observed in three patients, all of whom underwent additional surgery with lymph node dissection (one of them also exhibited blood vessel invasion and a positive horizontal margin). No evidence of residual tumors or lymph node metastasis was observed in any of the patients. No recurrence was observed in any of the 10 patients (mean follow-up period: 18.6 months). One patient (10.0%) experienced intraoperative bleeding. Perforation occurred in 1 patient (10.0%), but the condition was managed well by conservative therapy. Conclusion EMR-L was an acceptable method for endoscopically resecting submucosal duodenal NETs, and the NETs resected by EMR-L were tumor-negative in the vertical margins.
目的 经内镜黏膜切除术（EMR）切除的神经内分泌肿瘤（NETs）的垂直切缘常为肿瘤阳性。我们研究使用结扎装置的内镜黏膜切除术（EMR-L）治疗位于黏膜下层且无转移的十二指肠NETs的疗效。EMR-L操作所需技术难度较低，且结扎装置可降低垂直切缘阳性率。方法 连续纳入10例经EMR-L切除10个十二指肠NETs的患者。所有病变均位于黏膜下层，评估无转移，经内镜活检病理确诊为NETs。对内镜结果、病理结果及预后进行全面检查。结果 整块切除率和内镜下完全切除率均为100%。7个病变（70.0%）病理上实现了完全切除。所有病例的垂直切缘均为阴性。3例患者观察到淋巴管侵犯，均接受了额外的淋巴结清扫手术（其中1例还存在血管侵犯和水平切缘阳性）。所有患者均未发现残留肿瘤或淋巴结转移的证据。10例患者均未复发（平均随访期：18.6个月）。1例患者（10.0%）术中出血。1例患者（10.0%）发生穿孔，但经保守治疗病情得到良好控制。结论 EMR-L是内镜下切除十二指肠黏膜下NETs的一种可接受的方法，且经EMR-L切除的NETs垂直切缘为肿瘤阴性。
