Zhang XL, Jiang YY, Chang YY, Sun YL, Zhou Y, Wang YH, Dou XT, Guo HM, Ling TS. Endoscopic full-thickness resection: A definitive solution for local complete resection of small rectal neuroendocrine neoplasms. World J Gastroenterol 2025; 31(10): 100444 [DOI: 10.3748/wjg.v31.i10.100444]
Corresponding Author of This Article
Ting-Sheng Ling, PhD, Professor, Digestive Endoscopy Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, No. 155 Hanzhong Road, Qinhuai District, Nanjing 210029, Jiangsu Province, China. chinalts2024@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
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/
Xiao-Long Zhang, Yu-Li Sun, Ying Zhou, Ting-Sheng Ling, Digestive Endoscopy Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
Yang-Yang Jiang, Ying-Ying Chang, Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
Yao-Hui Wang, Department of Pathology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
Xiao-Tan Dou, Hui-Min Guo, Department of Gastroenterology, Nanjing Drum Tower Hospital, Nanjing 210008, Jiangsu Province, China
Co-first authors: Xiao-Long Zhang and Yang-Yang Jiang.
Author contributions: Zhang XL, Jiang YY, and Ling TS designed the research study; Chang YY, Sun YL, Zhou Y, Wang YH, Dou XT, and Guo HM performed the research. Both of Zhang XL and Jiang YY have made equally significant contributions to the work and share equal responsibility and accountability for it as co-first authors of this manuscript.
Supported by National Natural Science Foundation of China, No. 82004298; and Jiangsu Graduate Research and Practice Innovation Program, China, No. KYCX23_2090.
Institutional review board statement: The study was reviewed and approved by the Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine Committee (approval No. 2022NL-CAMT-014).
Informed consent statement: The committee exempted patients from informed consent because it was a retrospective cohort study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Dataset available from the corresponding author at chinalts@njucm.edu.cn.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ting-Sheng Ling, PhD, Professor, Digestive Endoscopy Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, No. 155 Hanzhong Road, Qinhuai District, Nanjing 210029, Jiangsu Province, China. chinalts2024@163.com
Received: August 16, 2024 Revised: December 11, 2024 Accepted: February 10, 2025 Published online: March 14, 2025 Processing time: 193 Days and 14.9 Hours
Abstract
BACKGROUND
Recently, several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms (R-NENs). However, none of these methods can achieve 100% complete resection (CR), particularly in the vertical direction. Endoscopic full-thickness resection (EFTR) has proven to be an effective method for the treatment of submucosal tumors but is seldom utilized in the eradication of R-NENs.
AIM
To review cases of R-NENs removed using EFTR and to evaluate the safety and efficacy of this technique.
METHODS
This retrospective cohort study enrolled 160 patients with pathologically confirmed R-NENs, including 132 who underwent endoscopic submucosal dissection (ESD) and 28 who underwent EFTR. Lesions were categorized as < 1 cm, 1-2 cm, and > 2 cm in size. CR rate, en bloc resection rate, operation time, and complications were evaluated. Subgroup analyses and follow-up were also performed.
RESULTS
EFTR achieved 100% CR rates for lesions < 1 cm and 1-2 cm, compared with 67.0% and 50.0%, respectively, in the ESD group. En bloc resection and successful removal of the R-NENs were achieved in all patients. Meanwhile, EFTR showed performance comparable to ESD in terms of operation time, hospitalization cost, and postoperative adverse events, except for a one-day longer hospital stay. We also analyzed the invasion depth of R-NENs based on full-thickness specimens. The data showed that 80% of lesions (< 1 cm) and 85.7% of lesions (1-2 cm) had invaded the SM3 level or deeper at the time of resection. For ESD specimens, 46.6% (< 1 cm) and 89.3% (1-2 cm) of lesions had infiltrated more than 2000 μm beneath the muscularis mucosae.
CONCLUSION
EFTR has shown superior performance in the resection of small R-NENs compared with that of ESD.
Core Tip: This retrospective cohort study included 160 patients with rectal neuroendocrine neoplasms who underwent endoscopic full-thickness resection or endoscopic submucosal dissection. Despite similar procedural durations and costs, endoscopic full-thickness resection (EFTR) achieved a 100% complete resection rate, a significant improvement compared to endoscopic submucosal dissection. Additionally, EFTR demonstrated a one-day longer hospital stay with no complications observed. This study indicates EFTR’s potential as a viable alternative for small, deeply infiltrating rectal neuroendocrine neoplasms, highlighting the importance of vertical resection depth for complete tumor eradication.
