Zheng Jian-Chun, Zheng Kai, Zhao Shuai, Wang Zhen-Ning, Xu Hui-Mian, Jiang Cheng-Gang
Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, China.
Z Gastroenterol. 2020 Feb;58(2):137-145. doi: 10.1055/a-1062-8897. Epub 2020 Feb 12.
Rectal neuroendocrine tumors are rare with good prognosis. Several endoscopic methods such as endoscopic polypectomy, endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and modified endoscopic mucosal resection (m-EMR) are used in the treatment of rectal neuroendocrine tumors. Although m-EMR is derived from traditional EMR, it has not been widely used in clinical practice. In this study, we compared the efficacy and safety of EMR and m-EMR in the treatment of rectal neuroendocrine tumors by performing a meta-analysis.
We searched PubMed, Web of Science, and EMBASE index up to the end of January 2017 for all published literature about EMR and m-EMR in the treatment of rectal neuroendocrine tumors.
A total of 11 studies involving 811 patients were included. The pooled data suggested that there was a significantly higher rate of histologic complete resection and endoscopic complete resection among patients treated with m-EMR than those treated with EMR (histologic complete resection: OR = 0.23, 95 % CI = 0.10-0.51, p < 0.01; endoscopic complete resection: OR = 0.13, 95 % CI = 0.02-0.74, p = 0.02). The procedure time of EMR was longer than m-EMR (MD = 2.40, 95 % CI = 0.33-4.46, p = 0.02). There was a significantly higher rate of vertical margin involvement among patients treated with EMR than those treated with m-EMR; whereas, there was no significant difference of lateral margin involvement between the m-EMR and EMR groups (vertical margin involvement: OR = 5.00, 95 % CI = 2.67-9.33, p < 0.01; lateral margin involvement: OR = 1.44, 95 % CI = 0.48-4.37, p = 0.52). There was no significant difference in mean tumor size among patients treated with m-EMR versus those treated with EMR (MD = -0.30, 95 % CI = -0.75-0.14, p = 0.18); further, there was no significant difference in endoscopic mean sizes of the tumor and pathological mean sizes of the tumor between the m-EMR and EMR groups (endoscopic mean sizes of the tumor: MD = 0.20, 95 % CI = -0.44-0.84, p = 0.43; pathological mean sizes of the tumor: MD = 0.62, 95 % CI = -0.68-1.92, p = 0.05). No significant differences were detected among the treatment groups with regard to complications (bleeding: OR = 0.87, 95 % CI = 0.39-1.95, p = 0.73; complications (bleeding and perforation): OR = 0.87, 95 % CI = 0.40-1.88, p = 0.73).
The efficacy of m-EMR are better than EMR among patients undergoing endoscopic treatment of rectal neuroendocrine tumors, and the safety of m-EMR is equivalent to EMR treatment.
直肠神经内分泌肿瘤较为罕见，预后良好。多种内镜方法，如内镜息肉切除术、内镜黏膜下剥离术（ESD）、内镜黏膜切除术（EMR）和改良内镜黏膜切除术（m-EMR）被用于治疗直肠神经内分泌肿瘤。尽管m-EMR源自传统EMR，但尚未在临床实践中广泛应用。在本研究中，我们通过进行荟萃分析比较了EMR和m-EMR治疗直肠神经内分泌肿瘤的疗效和安全性。
我们检索了截至2017年1月底的PubMed、科学网和EMBASE数据库中所有关于EMR和m-EMR治疗直肠神经内分泌肿瘤的已发表文献。
共纳入11项研究，涉及811例患者。汇总数据表明，接受m-EMR治疗的患者组织学完全切除率和内镜完全切除率显著高于接受EMR治疗的患者（组织学完全切除：OR = 0.23，95%CI = 0.10 - 0.51，p < 0.01；内镜完全切除：OR = 0.13，95%CI = 0.02 - 0.74，p = 0.02）。EMR的手术时间长于m-EMR（MD = 2.40，95%CI = 0.33 - 4.46，p = 0.02）。接受EMR治疗的患者垂直切缘受累率显著高于接受m-EMR治疗的患者；而m-EMR组和EMR组的侧切缘受累率无显著差异（垂直切缘受累：OR = 5.00，95%CI = 2.67 - 9.33，p < 0.01；侧切缘受累：OR = 1.44，95%CI = 0.48 - 4.37，p = 0.52）。接受m-EMR治疗的患者与接受EMR治疗的患者的平均肿瘤大小无显著差异（MD = -0.30，95%CI = -0.75 - 0.14，p = 0.18）；此外，m-EMR组和EMR组的肿瘤内镜平均大小和肿瘤病理平均大小无显著差异（肿瘤内镜平均大小：MD = 0.20，95%CI = -0.44 - 0.84，p = 0.43；肿瘤病理平均大小：MD = 0.62，95%CI = -0.68 - 1.92，p = 0.05）。各治疗组在并发症方面未检测到显著差异（出血：OR = 0.87，95%CI = 0.39 - 1.95，p = 0.73；并发症（出血和穿孔）：OR = 0.87，95%CI = 0.40 - 1.88，p = 0.73）。
在接受内镜治疗的直肠神经内分泌肿瘤患者中，m-EMR的疗效优于EMR，且m-EMR的安全性与EMR治疗相当。
