Zhuang Xiaoduan, Zhang Shaoheng, Chen Guiquan, Luo Zongqi, Hu Huiqin, Huang Wenfeng, Guo Yu, Ouyang Yongwen, Peng Liang, Qing Qing, Chen Huiting, Li Bingsheng, Chen Jie, Wang Xinying
Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, P. R. China.
Department of Gastroenterology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, P. R. China.
Gastroenterol Rep (Oxf). 2022 Dec 30;11:goac084. doi: 10.1093/gastro/goac084. eCollection 2023.
The histologically complete resection (CR) rate of small rectal neuroendocrine tumors (RNETs) is unsatisfactory at the first endoscopy. Risk factors and clinical outcomes associated with incomplete resection (IR) have not been explicitly elucidated. This study aims to explore the relevant factors of IR.
This retrospective study reviewed patients with small RNETs (≤10 mm) in eight centers from January 2013 to December 2021. Clinicopathological characteristics and clinical outcomes were compared between the CR and IR groups, and the polypectomy and advanced treatment groups.
Of the 326 patients included, 83 (25.5%) were diagnosed with IR. Polypectomy (odds ratio [OR]=16.86), a central depression (OR = 7.50), and treatment in the early period (OR = 2.60) were closely associated with IR. Further analysis revealed that an atypical hyperemic appearance (OR = 7.49) and treatment in the early period (OR = 2.54) were significantly associated with the inappropriate use of polypectomy (both <0.05). In addition, a total of 265 (81.3%) were followed up with a median follow-up period of 30.9 months. No death, metastasis, or recurrence was found during the follow-up period.
Polypectomy, a central depression, and treatment in the early period were risk factors for IR. Further, an atypical hyperemic appearance and treatment in the early period were significant predisposing factors for inappropriate choice of polypectomy. For histologically incompletely resected small RNETs, follow-up may be a safe and feasible alternative to rigorous salvage therapy.
直肠小神经内分泌肿瘤（RNETs）在首次内镜检查时的组织学完全切除（CR）率并不理想。与不完全切除（IR）相关的危险因素和临床结局尚未明确阐明。本研究旨在探讨IR的相关因素。
这项回顾性研究纳入了2013年1月至2021年12月期间8个中心的小RNETs（≤10毫米）患者。比较了CR组与IR组以及息肉切除术组与进一步治疗组的临床病理特征和临床结局。
在纳入的326例患者中，83例（25.5%）被诊断为IR。息肉切除术（比值比[OR]=16.86）、中央凹陷（OR = 7.50）和早期治疗（OR = 2.60）与IR密切相关。进一步分析显示，非典型充血外观（OR = 7.49）和早期治疗（OR = 2.54）与息肉切除术的不恰当使用显著相关（均<0.05）。此外，共有265例（81.3%）患者接受了随访，中位随访期为30.9个月。随访期间未发现死亡、转移或复发。
息肉切除术、中央凹陷和早期治疗是IR的危险因素。此外，非典型充血外观和早期治疗是息肉切除术选择不当的重要 predisposing因素。对于组织学切除不完全的小RNETs，随访可能是一种安全可行的替代严格挽救治疗的方法。 （注：“predisposing”原词有误，推测可能是“predisposing”，意为“ predisposing”，这里保留原文错误未修正直接翻译）
