Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.
Surg Endosc. 2023 Jul;37(7):5196-5204. doi: 10.1007/s00464-023-09999-4. Epub 2023 Mar 22.
The efficacy of endoscopic resection for of 10-20 mm rectal neuroendocrine tumor (NET) remains controversial. We aimed to evaluate the clinical outcomes and risk factors associated with poor prognosis after endoscopic resection of 10-20 mm rectal NET and to determine the optimal treatment.
Patients who underwent endoscopic resection for rectal NET in four tertiary hospitals were enrolled, and data on with the clinical outcomes and risk factors related to poor prognosis were retrospectively analyzed.
A total of 105 patients who underwent endoscopic submucosal resection (ESD; n = 65, 61.9%), modified endoscopic mucosal resection (mEMR; n = 31, 29.5%), and conventional EMR (cEMR; n = 9, 8.6%) were enrolled. The mean follow-up period was 41.2 ± 21.9 months. In the morphologic findings, the mean diameter was 11.6 mm (range 10-19); the shape was sessile (50.5%) and mixed type (49.5%), and surface depression was observed in 41.9% of patients. In the histologic findings, 87.6% of patients had G1 and 12.4% G2 tumor grade, and 3.8% of patients had lymphovascular invasion. The overall en bloc and histologically complete (R0) resections were 99.1% and 76.2%, respectively. cEMR was a less-frequently developed R0 resection. In the univariate and multivariate analyses for R0 resection, only surface depression was significantly associated. Regional or distant organs metastasis during follow-up developed in three patients (2.9%) and was significantly associated with female sex, redness, G2 tumor grade, and non-ESD methods.
Patients who underwent endoscopic resection of 10-20 mm rectal NET had good prognosis; therefore, endoscopic resection can be considered as the first-line treatment, particularly for 10-14 mm rectal NET. However, the risk factors, such as female sex, redness, G2 tumor grade and non-ESD methods, were associated with regional or distant metastases during follow-up. Therefore, patients with these risk factors should be carefully monitored.
内镜切除 10-20mm 直肠神经内分泌肿瘤（NET）的疗效仍存在争议。本研究旨在评估内镜切除 10-20mm 直肠 NET 的临床结局和与不良预后相关的危险因素，并确定最佳治疗方法。
在四家三级医院中，对接受内镜切除直肠 NET 的患者进行了回顾性分析，收集了与临床结局和不良预后相关的危险因素的数据。
共纳入 105 例接受内镜黏膜下切除术（ESD；n=65，61.9%）、改良内镜黏膜切除术（mEMR；n=31，29.5%）和常规 EMR（cEMR；n=9，8.6%）的患者。平均随访时间为 41.2±21.9 个月。在形态学发现方面，肿瘤平均直径为 11.6mm（范围 10-19mm）；形状为息肉样（50.5%）和混合类型（49.5%），41.9%的患者表面凹陷。在组织学发现方面，87.6%的患者为 G1 级肿瘤，12.4%为 G2 级肿瘤，3.8%的患者有血管淋巴管侵犯。整块和完全（R0）切除的总体率分别为 99.1%和 76.2%。cEMR 较少能实现 R0 切除。在 R0 切除的单因素和多因素分析中，只有表面凹陷与 R0 切除显著相关。在随访期间，有 3 名患者（2.9%）发生了区域性或远处器官转移，且与女性、红色、G2 级肿瘤和非 ESD 方法显著相关。
接受内镜切除 10-20mm 直肠 NET 的患者具有良好的预后，因此，内镜切除可以被视为一线治疗方法，特别是对于 10-14mm 直肠 NET。然而，女性、红色、G2 级肿瘤和非 ESD 方法等危险因素与随访期间的区域性或远处转移有关。因此，这些危险因素的患者应密切监测。
