Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2015; 21(30): 9142-9149
Published online Aug 14, 2015. doi: 10.3748/wjg.v21.i30.9142
Full-thickness excision using transanal endoscopic microsurgery for treatment of rectal neuroendocrine tumors
Wei-Jie Chen, Nan Wu, Jiao-Lin Zhou, Guo-Le Lin, Hui-Zhong Qiu
Wei-Jie Chen, Nan Wu, Jiao-Lin Zhou, Guo-Le Lin, Hui-Zhong Qiu, Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
Author contributions: Chen WJ and Wu N contributed equally to this work, performed the research and wrote the manuscript; Zhou JL analyzed the data; Lin GL and Qiu HZ designed and supervised the study; all authors have read and approved the final version to be published.
Institutional review board statement: The study was reviewed and approved by the Peking Union Medical College Hospital Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No financial support or incentive has been provided for this manuscript. All authors have no conflicts of interest or financial ties to disclose.
Data sharing statement: We would share our technical appendix, statistical code, and dataset available from the corresponding author at [guolelin2002@163.com]. Participants gave informed consent for data.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Guo-Le Lin, MD, Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Shuaifuyuan 1, Beijing 100730, China. linguole@126.com
Telephone: +86-10-69152621 Fax: +86-10-69156002
Received: February 25, 2015
Peer-review started: February 26, 2015
First decision: March 26, 2015
Revised: April 9, 2015
Accepted: May 7, 2015
Article in press: May 7, 2015
Published online: August 14, 2015
Abstract

AIM: To assess the efficacy of full-thickness excision using transanal endoscopic microsurgery (TEM) in the treatment of rectal neuroendocrine tumors.

METHODS: We analyzed the data of all rectal neuroendocrine tumor patients who underwent local full-thickness excision using TEM between December 2006 and December 2014 at our department. Data collected included patient demographics, tumor characteristics, operative details, postoperative outcomes, pathologic findings, and follow-ups.

RESULTS: Full-thickness excision using TEM was performed as a primary excision (n = 38) or as complete surgery after incomplete resection by endoscopic polypectomy (n = 21). The mean size of a primary tumor was 0.96 ± 0.21 cm, and the mean distance of the tumor from the anal verge was 8.4 ± 1.4 cm. The mean duration of the operation was 57.6 ± 13.7 min, and the mean blood loss was 13.5 ± 6.6 mL. No minor morbidities, transient fecal incontinence, or wound dehiscence was found. Histopathologically, all tumors showed typical histology without lymphatic or vessel infiltration, and both deep and lateral surgical margins were completely free of tumors. Among 21 cases of complete surgery after endoscopic polypectomy, 9 were histologically shown to have a residual tumor in the specimens obtained by TEM. No additional radical surgery was performed. No recurrence was noted during the median of 3 years’ follow-up.

CONCLUSION: Full-thickness excision using TEM could be a first surgical option for complete removal of upper small rectal neuroendocrine tumors.

Keywords: Transanal endoscopic microsurgery, Rectal neuroendocrine tumor, Full-thickness excision, Primary excision, Complete excision, Retrospective study

Core tip: Rectal neuroendocrine tumors increase quickly and steadily. Although transanal endoscopic microsurgery (TEM) was widely used for rectal neoplasms, the application of TEM in the full-thickness excision of rectal neuroendocrine tumors has not been well investigated. We analyzed data of all rectal neuroendocrine tumor patients who underwent local full-thickness excision using TEM as a primary excision or as complete surgery after incomplete resection by endoscopic polypectomy. The results suggested that full-thickness excision using TEM is a safe, minimally invasive procedure which could achieve complete resection, and might be a first surgical option for complete removal of higher rectal neuroendocrine tumors of less than 2 cm.