Park Jung-Bin, Kim Ga Hee, Kim Minjun, Hong Seung Wook, Hwang Sung Wook, Park Sang Hyoung, Ye Byong Duk, Byeon Jeong-Sik, Myung Seung-Jae, Yang Suk-Kyun, Lim Seok-Byung, Hong Seung-Mo, Yang Dong-Hoon
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Digestive Disease Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Dig Liver Dis. 2025 Jul;57(7):1473-1480. doi: 10.1016/j.dld.2025.03.023. Epub 2025 Apr 18.
Rectal neuroendocrine tumors (r-NETs) are often misidentified as polyps, leading to inappropriate endoscopic treatment and incomplete resection.
This study investigated the occurrence and risk factors of residual r-NETs following salvage local resection (SLR) after incomplete resection.
The medical records of 95 patients who underwent SLR for histologically incompletely resected (R1/Rx-resected) r-NETs referred from other hospitals between January 2020 and August 2023 were analyzed.
The residual r-NET rate was 48.4 % (46/95), varying according to the primary resection method: cold forceps polypectomy (CFP), 70.0 % (21/30); conventional polypectomy or endoscopic mucosal resection (EMR), 41.7 % (25/60); and modified EMR or endoscopic submucosal dissection, 0 % (0/5). The residual r-NET rate was 65.7 % for endoscopically incomplete primary resection versus 0 % for endoscopically complete primary resection. Upon multivariate analysis, endoscopically suspected remnant tumors before SLR (odds ratio [OR], 15.56; 95 % confidence interval [CI], 2.94-82.35, p = 0.002) and the use of CFP for primary resection (OR, 3.60; 95 % CI, 1.02-14.52, p = 0.043) were associated with residual r-NETs after SLR.
Salvage resection should be considered for R1/Rx-resected r-NET cases with risk factors for residual tumors to lower the likelihood of recurrence.
直肠神经内分泌肿瘤（r-NETs）常被误诊为息肉，导致不适当的内镜治疗和切除不完全。
本研究调查了不完全切除后挽救性局部切除（SLR）后残留r-NETs的发生情况及危险因素。
分析了2020年1月至2023年8月间从其他医院转诊来的95例组织学切除不完全（R1/Rx切除）的r-NETs患者接受SLR的病历。
残留r-NETs率为48.4%（46/95），根据初次切除方法而异：冷活检钳息肉切除术（CFP），70.0%（21/30）；传统息肉切除术或内镜黏膜切除术（EMR），41.7%（25/60）；改良EMR或内镜黏膜下剥离术，0%（0/5）。内镜下初次切除不完全时残留r-NETs率为65.7%，而内镜下初次切除完全时为0%。多因素分析显示，SLR前内镜怀疑有残留肿瘤（比值比[OR]，15.56；95%置信区间[CI]，2.94-82.35，p = 0.002）以及初次切除使用CFP（OR，3.60；95%CI，1.02-14.52，p = 0.043）与SLR后残留r-NETs相关。
对于有残留肿瘤危险因素的R1/Rx切除的r-NET病例，应考虑挽救性切除以降低复发可能性。
