Nakatani Shinya, Hayasaka Junnosuke, Ishii Tsuyoshi, Oda Minoru, Kawai Yusuke, Yamato Hiroshi, Ochiai Yorinari, Suzuki Yugo, Mitsunaga Yutaka, Odagiri Hiroyuki, Matsui Akira, Miura Yasuro, Hoteya Shu
Department of Gastroenterology Toranomon Hospital Tokyo Japan.
Department of Pathology Toranomon Hospital Tokyo Japan.
DEN Open. 2025 Sep 2;6(1):e70199. doi: 10.1002/deo2.70199. eCollection 2026 Apr.
The usefulness of endoscopic submucosal dissection (ESD) for rectal neuroendocrine tumors (NETs) is well established. However, factors influencing resection time remain unclear. This study aimed to identify these factors during ESD for rectal NETs.
This retrospective study included 194 rectal NET lesions that were treated with ESD at our institution between March 2011 and July 2024. Potential factors influencing resection time-including age, sex, operator experience (non-expert endoscopist: <50 colorectal ESD cases), sodium hyaluronate use, traction device (TD) use, tumor location, lesion size, and specimen area-were analyzed using multiple regression analysis.
The median resection time was 30 min (interquartile range [IQR]: 20-43 min). Non-expert endoscopists performed 53% of the procedures. The median specimen area was 302 mm (IQR: 233-393 mm). Resection time was significantly longer when procedures were performed by non-experts (β = 8.66; 95% confidence interval [CI]: 4.46-12.86; <0.001), when the tumor was located in the upper rectum (Rs) compared to the lower rectum (Rb) (β = 20.96; 95% CI: 7.82-34.1; = 0.002), and with increasing specimen area (β = 0.04; 95% CI: 0.027-0.06; <0.001). Conversely, TD use significantly shortened resection time (β = -5.90; 95% CI: -11.37 to -0.43; = 0.036).
Traction device use during ESD for rectal NETs is associated with shorter resection time; whereas, procedures performed by non-experts, tumors located in the Rs, and larger specimen areas were associated with longer resection time.
内镜下黏膜剥离术（ESD）治疗直肠神经内分泌肿瘤（NETs）的有效性已得到充分证实。然而，影响切除时间的因素仍不明确。本研究旨在确定直肠NETs行ESD时的这些因素。
本回顾性研究纳入了2011年3月至2024年7月间在我院接受ESD治疗的194例直肠NET病变。使用多元回归分析潜在影响切除时间的因素，包括年龄、性别、术者经验（非专家内镜医师：<50例结直肠ESD病例）、透明质酸钠使用情况、牵引装置（TD）使用情况、肿瘤位置、病变大小和标本面积。
中位切除时间为30分钟（四分位间距[IQR]：20 - 43分钟）。非专家内镜医师完成了53%的手术。中位标本面积为302平方毫米（IQR：233 - 393平方毫米）。非专家进行手术时切除时间显著更长（β = 8.66；95%置信区间[CI]：4.46 - 12.86；P < 0.001），与直肠下段（Rb）相比，肿瘤位于直肠上段（Rs）时（β = 20.96；95% CI：7.82 - 34.1；P = 0.002），以及标本面积增加时（β = 0.04；95% CI：0.027 - 0.06；P < 0.001）。相反，使用TD显著缩短了切除时间（β = -5.90；95% CI：-11.37至-0.43；P = 0.036）。
直肠NETs行ESD时使用牵引装置与较短的切除时间相关；而由非专家进行手术、肿瘤位于Rs以及标本面积较大与较长的切除时间相关。
