Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan.
Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
Int J Colorectal Dis. 2021 Mar;36(3):559-567. doi: 10.1007/s00384-020-03826-1. Epub 2021 Jan 2.
For rectal neuroendocrine tumors (NETs) ≤ 10 mm, endoscopic resection is a standard treatment. However, there is no consensus whether additional surgery should be performed for patients at risk of lymph node metastasis (LNM) after endoscopic resection. The purpose of this study was to analyze the results of endoscopic resection and additional surgery of rectal NETs, thereby clarify the characteristics of cases with LNM.
This study was a multicenter retrospective cohort study conducted at 12 Japanese institutions. A total of 132 NETs ≤ 10 mm were analyzed regarding various therapeutic results. A comparative analysis was performed by dividing the cases into two groups that underwent additional surgery or not. Furthermore, the relationship between tumor size and LNM was examined.
The endoscopic treatments were 12 endoscopic mucosal resections (EMR), 58 endoscopic submucosal resections with ligation (ESMR-L), 29 precutting EMRs, and 33 endoscopic submucosal dissections (ESD). The R0 resection rates of EMR were 41.7%, and compared to this rate, other three treatments were 86.2% (p < 0.001), 86.2% (p = 0.005), and 97.0% (p < 0.001), respectively. There were 41 non-curative cases (31.1%), and 13 had undergone additional surgery. Then, LNM was observed in 4 of the 13 patients, with an overall rate of LNM of 3.0% (4/132). The rate of positive lymphatic invasion and the rate of LNM by tumor size ≤ 6 mm and 7-10 mm were 9.7 vs. 15.4% (p = 0.375) and 0 vs. 10.3% (p = 0.007).
A multicenter study revealed the priority of each endoscopic resection and the low rate of LNM for rectal NETs ≤ 6 mm.
对于直径≤10mm 的直肠神经内分泌肿瘤（NET），内镜下切除是标准治疗方法。然而，对于内镜切除后有淋巴结转移（LNM）风险的患者，是否应进行额外手术，目前尚无共识。本研究旨在分析直肠 NET 内镜下切除和额外手术的结果，从而明确发生 LNM 的病例特征。
本研究为在 12 家日本机构进行的多中心回顾性队列研究。共分析了 132 例直径≤10mm 的 NET，以评估各种治疗结果。通过将病例分为接受和不接受额外手术两组进行对比分析。此外，还研究了肿瘤大小与 LNM 的关系。
内镜治疗包括 12 例内镜黏膜切除术（EMR）、58 例内镜黏膜下结扎切除术（ESMR-L）、29 例预切开 EMR 和 33 例内镜黏膜下剥离术（ESD）。EMR 的 R0 切除率为 41.7%，与这一比率相比，其他三种治疗方法的 R0 切除率分别为 86.2%（p<0.001）、86.2%（p=0.005）和 97.0%（p<0.001）。非治愈病例有 41 例（31.1%），其中 13 例接受了额外手术。然后，在这 13 例患者中观察到 4 例 LNM，总体 LNM 率为 3.0%（4/132）。肿瘤大小≤6mm 和 7-10mm 的肿瘤淋巴管浸润阳性率和 LNM 率分别为 9.7%和 15.4%（p=0.375）和 0%和 10.3%（p=0.007）。
一项多中心研究揭示了直肠 NET 直径≤6mm 时每种内镜切除方法的优先顺序以及 LNM 的低发生率。
