Department of Gastroenterology and Hepatology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China.
Department of Endocrinology and Metabolism, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China.
J Gastrointest Surg. 2024 Mar;28(3):301-308. doi: 10.1016/j.gassur.2023.12.016. Epub 2024 Jan 23.
Conventional endoscopic mucosal resection (cEMR), EMR with a transparent cap, EMR using a ligation device (EMR-L), EMR after circumferential precutting (EMR-P), and endoscopic submucosal dissection (ESD) have been used for resecting rectal neuroendocrine tumors (r-NETs). However, there is no consensus regarding which is the best treatment. This study aimed to compare the outcomes of the aforementioned 5 techniques for resecting r-NETs by network meta-analysis.
Electronic databases (PubMed, Cochrane Library, Embase, Ovid Medline, and Web of Science) were systematically searched to include relevant studies published from inception to September 1, 2023. The en bloc resection rate, histologic complete resection rate, positive lateral margin rate, positive vertical margin rate, adverse events rate, and procedure time were compared.
A total of 27 studies with a total of 2112 r-NETs were included, and the mean diameter of tumors was 6.24 mm. Pairwise meta-analysis showed that EMR-L and ESD had higher en bloc resection and histologic complete resection rates and lower positive vertical margin rate than those of cEMR in resecting r-NETs. Compared with ESD, EMR-L and EMR-P achieved similar resection rates and significantly shortened the procedure time without increasing adverse events. The network meta-analysis evaluated the surface under the cumulative ranking curves and revealed that EMR-L was the best modality for treating r-NETs considering the comprehensive results of the en bloc resection rate, histologic complete resection rate, positive lateral margin rate, positive vertical margin rate, adverse events rate, and procedure time.
EMR-L should be recommended as the first-line endoscopic treatment for small r-NETs.
传统内镜下黏膜切除术（cEMR）、透明帽辅助内镜下黏膜切除术（EMR 加帽）、套扎器辅助内镜下黏膜切除术（EMR-L）、环周预切开内镜下黏膜切除术（EMR-P）和内镜黏膜下剥离术（ESD）已被用于切除直肠神经内分泌肿瘤（r-NETs）。然而，对于哪种治疗方法最好，目前尚无共识。本研究旨在通过网络荟萃分析比较上述 5 种技术切除 r-NETs 的疗效。
系统检索电子数据库（PubMed、Cochrane 图书馆、Embase、Ovid Medline 和 Web of Science），纳入从建库至 2023 年 9 月 1 日发表的相关研究。比较整块切除率、组织学完全切除率、侧向切缘阳性率、垂直切缘阳性率、不良事件发生率和手术时间。
共纳入 27 项研究，共 2112 例 r-NETs，肿瘤平均直径为 6.24 mm。两两荟萃分析显示，EMR-L 和 ESD 整块切除率和组织学完全切除率高于 cEMR，垂直切缘阳性率低于 cEMR。与 ESD 相比，EMR-L 和 EMR-P 具有相似的切除率，且显著缩短了手术时间，同时不增加不良事件。网络荟萃分析评估了累积排序曲线下面积，结果显示，考虑整块切除率、组织学完全切除率、侧向切缘阳性率、垂直切缘阳性率、不良事件发生率和手术时间的综合结果，EMR-L 是治疗 r-NETs 的最佳方法。
对于小 r-NETs，EMR-L 应被推荐为内镜治疗的一线方法。
