Department of Gastroenterology, University Medical Centre Utrecht, Utrecht, the Netherlands.
Department of Gastroenterology, Amstelland Hospital, Laan van de Helende Meesters 8, 1186 AM, Amstelveen, the Netherlands.
Int J Colorectal Dis. 2021 Mar;36(3):535-541. doi: 10.1007/s00384-020-03801-w. Epub 2020 Nov 23.
Rectal neuroendocrine tumours (NETs) often present as an incidental finding during colonoscopy. Complete endoscopic resection of low-grade NETs up to 10 mm is considered safe. Whether this is also safe for NETs up to 20 mm is unclear. We performed a nationwide study to determine the risk of lymph node and distant metastases in endoscopically removed NETs.
All endoscopically removed rectal NETs between 1990 and 2010 were identified using the national pathology database (PALGA). Each NET was stratified according to size, grade and resection margin. Follow-up was until February 2016.
Between 1990 and 2010, a total of 310 NETs smaller than 20 mm were endoscopically removed. Mean size of NETs was 7.4 mm (SD 3.5). In 49% of NETs (n = 153), no grade (G) could be assessed from the pathology report, 1% was G2 (n = 3), and the remaining NETs were G1. Median follow up was 11.6 years (range 4.9-26.0). During follow-up, 30 patients underwent surgical resection. Lymph node or distant metastasis was seen in 3 patients (1%) which all had a grade 2 NET. Mean time from endoscopic resection to diagnosis of metastases was 6.1 years (95% CI 2.9-9.2).
No lymph node or distant metastases were seen in endoscopically removed G1 NETs up to 20 mm during the long follow-up of this nationwide study. This adds evidence to the ENET guideline that endoscopic resection of G1 NETs up to 20 mm appears to be safe.
直肠神经内分泌肿瘤（NET）在结肠镜检查时常被偶然发现。对于低级别 NET，内镜下完全切除 10mm 以下的肿瘤被认为是安全的。但对于最大径 20mm 的 NET 是否安全尚不清楚。我们进行了一项全国性研究，旨在确定内镜切除的 NET 发生淋巴结和远处转移的风险。
使用全国病理数据库（PALGA），确定 1990 年至 2010 年间所有经内镜切除的直肠 NET。根据肿瘤大小、分级和切缘情况对每例 NET 进行分层。随访至 2016 年 2 月。
1990 年至 2010 年间，共内镜切除 310 例小于 20mm 的 NET。NET 平均最大径为 7.4mm（标准差 3.5）。49%（n=153）的 NET 无法从病理报告中评估分级（G），1%（n=3）为 G2，其余 NET 为 G1。中位随访时间为 11.6 年（范围 4.9-26.0）。随访期间，30 例患者接受了手术切除。3 例（1%）患者出现淋巴结或远处转移，均为 G2 NET。从内镜切除到诊断转移的平均时间为 6.1 年（95%可信区间 2.9-9.2）。
在这项全国性研究的长期随访中，未观察到内镜切除的最大径 20mm 以下的 G1 NET 发生淋巴结或远处转移。这为 ENET 指南提供了证据，即内镜切除最大径 20mm 以下的 G1 NET 似乎是安全的。
