Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan.
Department of Pathology, NTT Medical Center Tokyo, Tokyo, Japan.
Digestion. 2019;99(1):72-78. doi: 10.1159/000494416. Epub 2018 Dec 14.
BACKGROUND/AIMS: The therapeutic strategies for small rectal neuroendocrine tumors (NETs) have not been standardized. We examined the efficacy and safety of endoscopic submucosal resection with a ligation device (ESMR-L) and the long-term outcomes after endoscopic treatment.
A total of 181 patients with rectal NETs <10 mm who were treated between May 2002 and May 2017 were retrospectively enrolled. All the lesions had been resected using ESMR-L, and the follow-up strategies were determined according to the pathological examinations. The long-term outcomes after a 53-month follow-up period were also evaluated.
R0 resection was achieved in 180 cases (99.4%). Lymphovascular invasion was confirmed in 67 cases (37.0%), while a curative resection was achieved in 114 cases (63.0%). One perforation (0.6%) and 11 cases with delayed bleeding (6.1%) were observed. A multivariate logistic regression analysis revealed that a tumor size > 5 mm (OR 2.06; 95% CI 1.04-4.08, p = 0.04) was a significant independent predictor of the presence of lymphovascular invasion. Of the 67 patients with non-curative resections, 11 patients underwent additional surgery; lymph node metastasis was confirmed in 2 cases (18.2%). No local or distant metastases were observed during the follow-up period in 77 patients with a curative resection, 9 patients who received additional surgery, and 50 patients with non-curative resections.
ESMR-L is an easy, safe and effective treatment for rectal NETs <10 mm in diameter, and the prognosis of patients seems to be good, despite a relatively high rate of lymphovascular invasion.
背景/目的：小直肠神经内分泌肿瘤（NETs）的治疗策略尚未标准化。我们检查了内镜黏膜下切除术结扎装置（ESMR-L）的疗效和安全性以及内镜治疗后的长期结果。
回顾性纳入 2002 年 5 月至 2017 年 5 月期间接受治疗的 181 例直肠 NETs <10mm 的患者。所有病变均采用 ESMR-L 切除，根据病理检查确定随访策略。还评估了 53 个月随访期后的长期结果。
R0 切除在 180 例（99.4%）中获得。确认有 67 例（37.0%）存在血管淋巴管侵犯，而 114 例（63.0%）获得了根治性切除。观察到 1 例穿孔（0.6%）和 11 例延迟出血（6.1%）。多因素逻辑回归分析显示，肿瘤大小> 5mm（OR 2.06；95%CI 1.04-4.08，p=0.04）是存在血管淋巴管侵犯的显著独立预测因子。在 67 例非根治性切除的患者中，11 例患者接受了额外手术；2 例（18.2%）证实有淋巴结转移。在 77 例根治性切除、9 例接受额外手术和 50 例非根治性切除的患者中，在随访期间未观察到局部或远处转移。
ESMR-L 是一种治疗直径<10mm 的直肠 NETs 的简单、安全、有效的方法，尽管血管淋巴管侵犯率相对较高，但患者的预后似乎良好。
