内镜黏膜下剥离术与经肛门内镜显微手术治疗 T1 期直肠神经内分泌肿瘤的对比：倾向评分匹配研究。
Comparison of endoscopic submucosal dissection and transanal endoscopic microsurgery for T1 rectal neuroendocrine tumors: a propensity score-matched study.
机构信息
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
Biostatistics Collaboration Team, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
出版信息
Gastrointest Endosc. 2021 Aug;94(2):408-415.e2. doi: 10.1016/j.gie.2021.02.012. Epub 2021 Feb 16.
BACKGROUND AND AIMS
Endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) are the most effective endoscopic resection methods for T1 rectal neuroendocrine tumors (NETs). We aimed to compare the efficacy and safety of ESD and TEM for rectal NETs ≤20 mm.
METHODS
Patients with rectal NETs ≤20 mm who underwent ESD or TEM were enrolled in this retrospective observational study. ESD and TEM groups were matched for pathologic tumor size and EMR history. We evaluated between-group differences in R0 resection rate, adverse event rate, procedure time, and hospital stay.
RESULTS
We included 285 patients (ESD = 226, TEM = 59) in the final cohort, with 104 patients in the matched groups (ESD = 52, TEM = 52). The R0 resection rate was significantly higher for TEM (ESD 71.2% vs TEM 92.3%, P = .005). However, the median procedure time (ESD 22 [range, 11-65] vs TEM 35 [17-160] minutes, P < .001) and hospital stay (ESD 2.5 range 1-5] vs TEM 4 [3-8] days, P < .001) were significantly shorter for ESD. In the subgroup analysis of patients divided by tumor size <10 mm (ESD = 218, TEM = 49) and 10 to 20 mm (ESD = 8, TEM = 10)], there was no significant between-group difference in the R0 resection rate (83.5% vs 93.9%, P = .063 and 37.5% vs 80%, P = .145, respectively) or the rate of recurrence.
CONCLUSIONS
Although TEM showed a better overall R0 resection rate for rectal NETs ≤20 mm, ESD could be a viable treatment modality concerning adverse events, procedure time, and hospital stay for rectal NETs <10 mm with similar R0 resection rates in comparison with TEM.
背景与目的
内镜黏膜下剥离术（ESD）和经肛门内镜显微手术（TEM）是治疗 T1 期直肠神经内分泌肿瘤（NET）最有效的内镜切除方法。本研究旨在比较 ESD 和 TEM 治疗直肠 NETs≤20mm 的疗效和安全性。
方法
本回顾性观察性研究纳入了接受 ESD 或 TEM 治疗的直肠 NETs≤20mm 的患者。ESD 组和 TEM 组根据病理肿瘤大小和内镜黏膜切除术（EMR）史进行匹配。我们评估了两组间 R0 切除率、不良事件发生率、手术时间和住院时间的差异。
结果
最终纳入 285 例患者（ESD=226 例，TEM=59 例），其中 104 例患者进行了匹配（ESD=52 例，TEM=52 例）。TEM 的 R0 切除率显著高于 ESD（ESD 为 71.2%，TEM 为 92.3%，P=0.005）。然而，ESD 的中位手术时间（ESD 为 22[范围 11-65]分钟，TEM 为 35[17-160]分钟，P<0.001）和住院时间（ESD 为 2.5[范围 1-5]天，TEM 为 4[3-8]天，P<0.001）明显更短。根据肿瘤大小<10mm（ESD=218 例，TEM=49 例）和 10-20mm（ESD=8 例，TEM=10 例）的患者亚组分析，两组间 R0 切除率（分别为 83.5%和 93.9%，P=0.063；37.5%和 80%，P=0.145）或复发率均无显著差异。
结论
尽管 TEM 显示出对直肠 NETs≤20mm 更好的总体 R0 切除率，但对于直径<10mm 的直肠 NETs，ESD 可能是一种可行的治疗方法，与 TEM 相比，ESD 具有相似的 R0 切除率，并且不良事件、手术时间和住院时间更少。
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