Hong Seung Min, Baek Dong Hoon
Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea.
Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
Clin Endosc. 2022 Jul;55(4):496-506. doi: 10.5946/ce.2022.115. Epub 2022 Jul 11.
Recently, research on rectal neuroendocrine tumors (NETs) has increased during the last few decades. Rectal NETs measuring <10 mm without atypical features and confined to the submucosal layer have only 1% risk of metastasis, and the long-term survival probability of patients without metastasis at the time of diagnosis is approximately 100%. Therefore, the current guidelines suggest endoscopic resection of rectal NETs of <10 mm is regarded as a safe therapeutic option. However, there are currently no clear recommendations for technique selection for endoscopic resection. The choice of treatment modality for rectal NETs should be based on the lesion size, endoscopic characteristics, grade of differentiation, depth of vertical involvement, lymphovascular invasion, and risk of metastasis. Moreover, the complete resection rate, complications, and experience at the center should be considered. Modified endoscopic mucosal resection is the most suitable resection method for rectal NETs of <10 mm, because it is an effective and safe technique that is relatively simple and less time-consuming compared with endoscopic submucosal dissection. Endoscopic submucosal dissection should be considered when the tumor size is >10 mm, suctioning is not possible due to fibrosis in the lesion, or when the snaring for modified endoscopic mucosal resection does not work well.
最近，在过去几十年里，关于直肠神经内分泌肿瘤（NETs）的研究有所增加。直径小于10毫米、无非典型特征且局限于黏膜下层的直肠NETs转移风险仅为1%，诊断时无转移的患者长期生存概率约为100%。因此，目前的指南建议，直径小于10毫米的直肠NETs的内镜切除被视为一种安全的治疗选择。然而，目前对于内镜切除的技术选择尚无明确建议。直肠NETs的治疗方式选择应基于病变大小、内镜特征、分化程度、垂直侵犯深度、淋巴管侵犯及转移风险。此外，还应考虑完整切除率、并发症及中心的经验。改良内镜黏膜切除术是直径小于10毫米的直肠NETs最适合的切除方法，因为与内镜黏膜下剥离术相比，它是一种有效且安全的技术，相对简单且耗时较少。当肿瘤大小大于10毫米、由于病变纤维化无法进行抽吸或改良内镜黏膜切除术的圈套术效果不佳时，应考虑内镜黏膜下剥离术。
