Department of Surgery, University of British Columbia, British Columbia, Vancouver, Canada.
Harvard T.H. Chan School of Public Health, Massachusetts, Boston, USA.
Colorectal Dis. 2023 May;25(5):1026-1035. doi: 10.1111/codi.16506. Epub 2023 Feb 23.
The objective of this study was to evaluate the safety and effectiveness of transanal endoscopic microsurgery for rectal neuroendocrine tumours.
A retrospective cohort study of all pathology-confirmed rectal neuroendocrine tumours treated by transanal endoscopic microsurgery from April 2007 to December 2020 at a tertiary care centre was performed. Demographic, clinical, radiographic and pathological data were collected. Characteristics of patients with recurrence were examined. Descriptive statistics were performed.
There were 58 patients treated by transanal endoscopic microsurgery excision. Referrals were for primary excision (15, 25.9%), completion re-excision after incomplete endoscopic removal (38, 65.5%) or locally recurrent rectal neuroendocrine tumours (5, 8.6%). The mean age of patients was 56.4 ± 11.9 years and 26 patients were women (44.8%). Mean tumour size was 7.4 ± 3.8 mm (range 1.0-15.0 mm). Most (86.4%) were Grade 1 tumours. Mean operative time was 37.2 ± 17.2 min and 56 patients (96.6%) were discharged on the same day. All patients had negative margins on final pathology. Of the 38 patients who were referred for completion re-excision after incomplete endoscopic removal, eight (21.1%) had residual tumour on final pathology. Three recurrences were diagnosed at 2.1, 4.5 and 12.5 years after excision. All recurrences were from Grade 1 or 2 primary tumours, less than 2 cm, and diagnosed radiographically.
To date, this is the largest North American study looking at transanal endoscopic microsurgery for rectal neuroendocrine tumours. This technique is effective in managing primary, incompletely excised and recurrent tumours with good clinical and oncological outcomes.
本研究旨在评估经肛门内镜微创手术治疗直肠神经内分泌肿瘤的安全性和有效性。
对 2007 年 4 月至 2020 年 12 月在一家三级保健中心接受经肛门内镜微创手术治疗的所有经病理证实的直肠神经内分泌肿瘤患者进行回顾性队列研究。收集了人口统计学、临床、影像学和病理学数据。检查了复发患者的特征。进行了描述性统计。
有 58 例患者接受了经肛门内镜微创手术切除。转诊的原因包括初次切除（15 例，25.9%）、内镜切除不完全后的完成性再切除（38 例，65.5%）或局部复发性直肠神经内分泌肿瘤（5 例，8.6%）。患者的平均年龄为 56.4±11.9 岁，26 例为女性（44.8%）。平均肿瘤大小为 7.4±3.8mm（范围 1.0-15.0mm）。大多数（86.4%）为 G1 级肿瘤。平均手术时间为 37.2±17.2 分钟，56 例（96.6%）患者在同一天出院。所有患者的最终病理均为阴性切缘。在因内镜切除不完全而被转诊行完成性再切除的 38 例患者中，8 例（21.1%）的最终病理有残留肿瘤。3 例复发分别发生在切除后 2.1、4.5 和 12.5 年。所有复发均来自 G1 或 G2 级的原发性肿瘤，小于 2cm，并经影像学诊断。
迄今为止，这是北美最大的研究经肛门内镜微创手术治疗直肠神经内分泌肿瘤的研究。该技术在管理原发性、不完全切除和复发性肿瘤方面是有效的，具有良好的临床和肿瘤学结果。
