Sun Di, Ren Zhong, Xu Enpan, Cai Shilun, Qi Zhipeng, Chen Zhanghan, Liu Jingyi, Shi Qiang, Zhou Pinghong, Zhong Yunshi
Endoscopy Center, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
Endoscopy Research Institute of Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
Surg Endosc. 2023 Apr;37(4):2644-2652. doi: 10.1007/s00464-022-09710-z. Epub 2022 Nov 15.
Endoscopic submucosal dissection (ESD) has been widely adopted in treating rectal neuroendocrine tumors (NETs). However, clinical outcomes in rectal NETs after ESD with different resection margin status remain scanty, particularly in patients with positive resection margins. This study aimed to evaluate the long-term clinical outcomes of ESD in rectal NET based on the resection margin status.
This retrospective study included 436 patients diagnosed with rectal NET who had undergone ESD. Clinical data, including age, sex, tumor size, stage, invasion, and the resection margin status, were collected. Further, the patients were assessed for complications, recurrence, distant metastasis, and long-term outcomes.
Among all 436 patients, 395 patients had their primary ESD in our hospital. Complete resection was achieved in 319 patients. Patients who did not achieve complete resection opted for follow-up (n = 73), salvage surgery (n = 1) and salvage ESD (n = 2). Another 41 had their primary ESD in other hospital with incomplete resection and had salvage ESD in our hospital. All 436 patients had a median follow-up period of 61.4 months (range 33.4-125.3 months). During the follow-up period, two patients developed recurrences, while three patients developed metastasis. There were no significant differences in the 5-year progression-free survival and overall survival between patients with incomplete resection opting for follow-up compared to the other two groups (P = 0.5/0.8). However, the complication rates were significantly higher in patients who received salvage ESD.
This study demonstrated that positive resection margins have no influence on survival in patients with rectal NET treated using ESD.
内镜黏膜下剥离术（ESD）已被广泛应用于直肠神经内分泌肿瘤（NETs）的治疗。然而，不同切缘状态的直肠NETs患者接受ESD后的临床结局仍然缺乏，尤其是切缘阳性的患者。本研究旨在评估基于切缘状态的直肠NETs患者ESD的长期临床结局。
本回顾性研究纳入了436例接受ESD治疗的直肠NETs患者。收集临床数据，包括年龄、性别、肿瘤大小、分期、浸润情况和切缘状态。此外，对患者进行并发症、复发、远处转移和长期结局评估。
在436例患者中，395例在我院接受了初次ESD。319例患者实现了完整切除。未实现完整切除的患者选择了随访（n = 73）、挽救性手术（n = 1）和挽救性ESD（n = 2）。另外41例在其他医院接受了初次ESD且切除不完整，在我院接受了挽救性ESD。436例患者的中位随访时间为61.4个月（范围33.4 - 125.3个月）。随访期间，2例患者出现复发，3例患者发生转移。选择随访的切缘不完整患者与其他两组患者相比，5年无进展生存率和总生存率无显著差异（P = 0.5/0.8）。然而，接受挽救性ESD的患者并发症发生率显著更高。
本研究表明，切缘阳性对接受ESD治疗的直肠NETs患者的生存没有影响。
