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Park SS, Kim BC, Lee DE, Chang HJ, Han KS, Kim B, Hong CW, Sohn DK, Lee DW, You K, Park SC, Oh JH. Stratification of risk for lymph node metastasis and long-term oncologic outcomes in patients initially treated by endoscopic resection for rectal neuroendocrine tumors. Gastrointest Endosc 2025; 101:1222-1232.e5. [PMID: 39608591 DOI: 10.1016/j.gie.2024.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/12/2024] [Accepted: 11/18/2024] [Indexed: 11/30/2024]
Abstract
BACKGROUND AND AIMS The treatment of rectal neuroendocrine tumors (NETs) is determined by the risk of lymph node (LN) metastasis. The aim of this study was to stratify the risk of LN metastasis according to the number of risk factors and evaluate the long-term outcomes of patients initially treated endoscopically for rectal NETs. METHODS We retrospectively analyzed 441 patients initially treated with endoscopy for rectal NETs; those who had at least 1 of the risk factors for LN metastasis were defined as high-risk patients. LN metastasis rates were stratified according to the number of risk factors. Five-year overall survival and recurrence-free survival were compared between the high- and low-risk groups. RESULTS Pathologic size (odds ratio [OR], 1.208; 95% confidence interval [CI], 1.062-1.374; P = .001), resection margin invasion (+) (OR, 2.897; 95% CI, 1.057-7.936; P = .039), and angiolymphatic invasion (OR, 22.155; 95% CI, 7.563-64.904; P = .001) were risk factors for LN metastasis. The rate of LN metastasis increased as the number of risk factors increased (P = .001). The 5-year recurrence-free survival rates were 98.7% and 99% in the high- and low-risk groups, respectively, with no significant difference (P = .966). The 5-year overall survival rates were 100% and 99.5% in the high- and low-risk groups, with no significant difference (P = .571). CONCLUSIONS The risk of LN metastasis increased significantly when the number of risk factors increased in patients with rectal NETs. Patients who initially underwent endoscopic resection for rectal NETs exhibited a favorable long-term oncologic outcome if salvage treatments were performed, depending on the stratification of their risk factors.
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Affiliation(s)
- Sung Sil Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Byung Chang Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea.
| | - Dong-Eun Lee
- Biostatistics Collaboration Team, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Hee Jin Chang
- Department of Pathology, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Kyung Su Han
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Bun Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Chang Won Hong
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Dae Kyung Sohn
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Dong Woon Lee
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Kiho You
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Sung Chan Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
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Liu JN, Chen H, Fang N. Current status of endoscopic resection for small rectal neuroendocrine tumors. World J Gastroenterol 2025; 31:106814. [DOI: 10.3748/wjg.v31.i19.106814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2025] [Revised: 03/21/2025] [Accepted: 04/27/2025] [Indexed: 05/21/2025] Open
Abstract
Rectal neuroendocrine tumor (rNET) is an indolent malignancy often detected during colonoscopy screening. The incidence of rNET has increased approximately 10-fold over the past 30 years. Most rNETs detected during screening endoscopy are small, measuring < 10 mm. Current guidelines recommend endoscopic resection for small, well-differentiated rNET using modified endoscopic submucosal resection (mEMR) or endoscopic submucosal dissection. However, the optimal endoscopic treatment method remains uncertain. This paper summarizes the evidence on mEMR with submucosal stretching, mEMR without submucosal stretching, endoscopic submucosal dissection and endoscopic full-thickness resection. Given that rNETs often exhibit submucosal invasion, achieving adequate resection depth is crucial to ensure histological complete resection. mEMR with submucosal stretching appears favorable due to its high rate of histological complete resection, safety and convenience. Risk factors associated with lymph node and distant metastases are also discussed. A treatment algorithm is proposed to facilitate clinical decision-making.
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Affiliation(s)
- Jian-Ning Liu
- Department of Gastroenterology, The Third Affiliated Hospital, Jiangxi Medical College, School of Queen Mary, Nanchang University, Nanchang 330009, Jiangxi Province, China
| | - Hui Chen
- Endoscopic Center, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi’an 710032, Shaanxi Province, China
| | - Nian Fang
- Department of Gastroenterology, The Third Affiliated Hospital, Jiangxi Medical College, School of Queen Mary, Nanchang University, Nanchang 330009, Jiangxi Province, China
- Department of Gastroenterology, The First Hospital of Nanchang, Nanchang 330009, Jiangxi Province, China
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Park JB, Kim GH, Kim M, Hong SW, Hwang SW, Park SH, Ye BD, Byeon JS, Myung SJ, Yang SK, Lim SB, Hong SM, Yang DH. Risk factors for residual tumors in histologically incompletely resected rectal neuroendocrine tumors. Dig Liver Dis 2025:S1590-8658(25)00303-2. [PMID: 40253226 DOI: 10.1016/j.dld.2025.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 02/26/2025] [Accepted: 03/22/2025] [Indexed: 04/21/2025]
Abstract
BACKGROUND Rectal neuroendocrine tumors (r-NETs) are often misidentified as polyps, leading to inappropriate endoscopic treatment and incomplete resection. AIMS This study investigated the occurrence and risk factors of residual r-NETs following salvage local resection (SLR) after incomplete resection. METHODS 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. RESULTS 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. CONCLUSION Salvage resection should be considered for R1/Rx-resected r-NET cases with risk factors for residual tumors to lower the likelihood of recurrence.
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Affiliation(s)
- Jung-Bin Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ga Hee Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Minjun Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Wook Hong
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Wook Hwang
- 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
| | - Sang Hyoung Park
- 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
| | - Byong Duk Ye
- 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
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, 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
| | - Suk-Kyun Yang
- 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
| | - Seok-Byung Lim
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, 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.
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Weng J, Chi J, Lv YH, Chen RB, Xu GL, Xia XF, Bai KH. Comparison of endoscopic submucosal dissection and transanal endoscopic microsurgery for stage 1 rectal neuroendocrine tumors. World J Gastrointest Endosc 2025; 17:99906. [PMID: 39989850 PMCID: PMC11843039 DOI: 10.4253/wjge.v17.i2.99906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 01/08/2025] [Accepted: 01/17/2025] [Indexed: 02/13/2025] Open
Abstract
BACKGROUND Stage 1 rectal neuroendocrine tumors (NETs) are best treated with endoscopic submucosal dissection (ESD) or transanal endoscopic microsurgery (TEM) for local resection. AIM To investigate the safety and efficacy of ESD and TEM for local resection of stage 1 rectal NETs. METHODS This retrospective observational analysis included patients with clinical stage 1 rectal NETs (cT1N0M0, less than 20 mm) who underwent ESD or TEM. The ESD and TEM groups were matched to ensure that they had comparable lesion sizes, lesion locations, and pathological grades. We assessed the differences between groups in terms of en bloc resection rate, R0 resection rate, adverse event rate, recurrence rate, and hospital stay and cost. RESULTS Totally, 128 Lesions (ESD = 84; TEM = 44) were included, with 58 Lesions within the matched groups (ESD = 29; TEM = 29). Both the ESD and TEM groups had identical en bloc resection (100.0% vs 100.0%, P = 1.000), R0 resection (82.8% vs 96.6%, P = 0.194), adverse event (0.0% vs 6.9%, P = 0.491), and recurrence (0.0% vs 3.4%, P = 1.000) rates. Nevertheless, the median hospital stay [ESD: 5.5 (4.5-6.0) vs TEM: 10.0 (7.0-12.0) days; P < 0.001], and cost [ESD: 11.6 (9.8-12.6) vs TEM: 20.9 (17.0-25.1) kilo-China Yuan, P < 0.001] were remarkably shorter and less for ESD. CONCLUSION Both ESD and TEM were well-tolerated and yielded favorable outcomes for the local removal of clinical stage 1 rectal NETs. ESD exhibits shorter hospital stay and fewer costs than TEM.
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Affiliation(s)
- Jun Weng
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Jun Chi
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Yan-Hua Lv
- Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Ruo-Bing Chen
- Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Guo-Liang Xu
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Xian-Feng Xia
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Kun-Hao Bai
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
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Lee HJ, Seo Y, Oh CK, Lee JM, Choi HH, Gweon TG, Lee SH, Cheung DY, Kim JI, Park SH, Lee HH. Assessing risk stratification in long-term outcomes of rectal neuroendocrine tumors following endoscopic resection: a multicenter retrospective study. Scand J Gastroenterol 2024; 59:868-874. [PMID: 38587111 DOI: 10.1080/00365521.2024.2340008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/18/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES While endoscopic resection of rectal neuroendocrine tumors (NETs) has significantly increased, long-term data on risk factors for recurrence are still lacking. Our aim is to analyze the long-term outcomes of patients with rectal NETs after endoscopic resection through risk stratification. METHODS In this multicenter retrospective study, we included patients who underwent endoscopic resection of rectal NETs from 2009 to 2018 and were followed for ≥12 months at five university hospitals. We classified the patients into three risk groups according to the clinicopathological status of the rectal neuroendocrine tumors: low, indeterminate, and high. The high-risk group was defined if the tumors have any of the followings: size ≥ 10 mm, lymphovascular invasion, muscularis propria or deeper invasion, positive resection margins, or mitotic count ≥2/10. RESULTS A total of 346 patients were included, with 144 (41.6%), 121 (35.0%), and 81 (23.4%) classified into the low-, indeterminate-, and high-risk groups, respectively. Among the high-risk group, seven patients (8.6%) received salvage treatment 28 (27-67) days after the initial endoscopic resection, with no reported extracolonic recurrence. Throughout the follow-up period, 1.1% (4/346) of patients experienced extracolonic recurrences at 56.5 (54-73) months after the initial endoscopic resection. Three of these patients (75%) were in the high-risk group and did not undergo salvage treatment. The risk of extracolonic recurrence was significantly higher in the high-risk group compared to the other groups (p = 0.039). CONCLUSION Physicians should be concerned about the possibility of metastasis during long-term follow-up of high-risk patients and consider salvage treatment.
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Affiliation(s)
- Hyun Jin Lee
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Internal Medicine, Myongji Hospital, Goyang, Republic of Korea
| | - Yun Seo
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Kyo Oh
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Gastroenterology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University of Korea, Seoul, Republic of Korea
| | - Ji Min Lee
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Hyun Ho Choi
- Department of Internal Medicine, Uijungbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijungbu, Republic of Korea
| | - Tae-Geun Gweon
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Sung-Hak Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dae Young Cheung
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Il Kim
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo-Heon Park
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Han Hee Lee
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Panzuto F, Parodi MC, Esposito G, Massironi S, Fantin A, Cannizzaro R, Milione M, De Angelis CG, Annibale B. Endoscopic management of gastric, duodenal and rectal NETs: Position paper from the Italian Association for Neuroendocrine Tumors (Itanet), Italian Society of Gastroenterology (SIGE), Italian Society of Digestive Endoscopy (SIED). Dig Liver Dis 2024; 56:589-600. [PMID: 38216439 DOI: 10.1016/j.dld.2023.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/14/2024]
Abstract
The present paper reflects the position of the Italian Association for Neuroendocrine Tumors (Itanet), the Italian Society of Gastroenterology (SIGE), and the Italian Society of Digestive Endoscopy (SIED) regarding the management of patients affected by gastric, duodenal, and rectal neuroendocrine neoplasms (NENs) amenable to endoscopic treatment. The key questions discussed in this paper are summarized in Table 1. Data were extracted from the MEDLINE database through searches; expert opinions and recommendations are provided in accordance with the available scientific evidence and the authors' expertise. Recommendations are presented alongside a level of evidence and grade of recommendation based on the GRADE system. This paper specifically focuses on subgroups of NENs considered suitable for endoscopic management according to current international guidelines: i. well-differentiated gastric neuroendocrine tumors (gNET) type 1 < 2 cm and selected cases of type 3; ii. well-differentiated duodenal, non-functioning, non-ampullary NET with size < 2 cm; and well-differentiated rectal NET with size < 2 cm.
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Affiliation(s)
- Francesco Panzuto
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy.
| | - Maria Caterina Parodi
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Teaching Hospital San Martino, Genova, Italy
| | - Gianluca Esposito
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - Sara Massironi
- Division of Gastroenterology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Alberto Fantin
- Gastroenterology Unit; Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Renato Cannizzaro
- Oncological Gastroenterology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Italy; Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
| | - Massimo Milione
- Pathology First Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudio Giovanni De Angelis
- Gastroenterology Department, Endoscopy Unit, Azienda Ospedaliero Universitaria, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Bruno Annibale
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
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Wang FG, Jiang Y, Liu C, Qi H. Comparison between Endoscopic Submucosal Dissection and Transanal Endoscopic Microsurgery in Early Rectal Neuroendocrine Tumor Patients: A Meta-Analysis. J INVEST SURG 2023; 36:2278191. [PMID: 37970828 DOI: 10.1080/08941939.2023.2278191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To compare the effectiveness, safety and cost-effectiveness of endoscopic submucosal dissection (ESD) with transanal endoscopic microsurgery (TEM) in early rectal neuroendocrine tumor (RNET) patients. This article will provide reliable evidence for surgeons in regards to clinical decision-making. METHODS Systematic literature retrieval was performed in Pubmed, Embase and Cochrane database from 2013/4/30 to 2023/4/30. Methodology validation was performed by using the Newcastle-Ottawa Scale (NOS). Data-analysis was conducted by using the Review manager version 5.3 software. RESULTS A total of three retrospective studies were included in our meta-analysis. All eligible studies were considered to be high quality. By comparing baseline characteristics between TEM and ESD, patients in the TEM group seemed to be characterized by a larger tumor size and lower tumor level, even though no statistical significance was found. Clear statistical significance favoring TEM was identified in terms of R0 resection rate, procedure time and hospital stay. No statistical significance was found in terms of recurrence rate, adverse events rate and additional treatment rate. CONCLUSIONS Compared with ESD, TEM was a more effective treatment modality for early RNET patients; it was associated with a relatively higher R0 resection rate and a similar degree of safety. However, the relatively higher cost and complicated manipulation restricted the promotion of TEM. Surgeons should opt for TEM as a primary treatment in patients with a larger tumor size and deeper degree of tumorous infiltration if the financial condition and hospital facility permit.
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Affiliation(s)
- Fu-Gang Wang
- Department of General Surgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, PR China
| | - Ying Jiang
- Department of Burn and Plastic Surgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, PR China
| | - Chao Liu
- Department of General Surgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, PR China
| | - Hong Qi
- Department of General Surgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, PR China
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Jin MJ, Park SS, Lee DE, Park SC, Lee DW, You K, Chang HJ, Hong CW, Sohn DK, Han KS, Kim B, Kim BC, Oh JH. Stratification of rate of lymph node metastasis according to risk factors and oncologic outcomes in patients who underwent radical resection for rectal neuroendocrine tumors. Ann Coloproctol 2023; 39:467-473. [PMID: 37105525 PMCID: PMC10781599 DOI: 10.3393/ac.2022.00913.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/31/2022] [Accepted: 02/22/2023] [Indexed: 04/29/2023] Open
Abstract
PURPOSE Most predictive factors for lymph node metastasis in rectal neuroendocrine tumors (NETs) have been based on local and endoscopic resection. We aimed to evaluate the risk factors for lymph node metastasis in patients who underwent radical resection for rectal NETs and stratify the risk of lymph node metastasis. METHODS Sixty-four patients who underwent radical resection for rectal NETs between January 2001 and January 2018 were included. We investigated the risk factors of lymph node metastasis using clinicopathologic data. We also performed a risk stratification for lymph node metastases using the number of previously known risk factors. For oncologic outcomes, the 5-year overall survival and recurrence-free survival were evaluated in both groups. RESULTS Among the patients who underwent radical surgery, 32 (50.0%) had lymph node metastasis and 32 (50.0%) had non-lymph node metastasis. In the multivariable analysis, only the male sex was identified as a risk factor for lymph node metastasis (odds ratio, 3.695; 95% confidence interval, 1.128-12.105; P=0.031). When there were 2 or more known risk factors, the lymph node metastasis rate was significantly higher than when there were one or no risk factors (odds ratio, 3.667; 95% confidence interval, 1.023-13.143; P=0.046). There was also no statistical difference between the 2 groups in 5-year overall survival (P=0.431) and 5-year recurrence-free survival (P=0.144). CONCLUSION We found that the rate of lymph node metastasis increased significantly when the number of known risk factors is 2 or more.
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Affiliation(s)
- Myung Jae Jin
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sung Sil Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Dong-Eun Lee
- Biostatistics Collaboration Team, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sung Chan Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Dong Woon Lee
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kiho You
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hee Jin Chang
- Department of Pathology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Chang Won Hong
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Dae Kyung Sohn
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kyung Su Han
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Bun Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Byung Chang Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Esposito G, Dell'Unto E, Ligato I, Marasco M, Panzuto F. The meaning of R1 resection after endoscopic removal of gastric, duodenal and rectal neuroendocrine tumors. Expert Rev Gastroenterol Hepatol 2023; 17:785-793. [PMID: 37497604 DOI: 10.1080/17474124.2023.2242261] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/26/2023] [Accepted: 07/25/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Well-differentiated gastric, duodenal, and rectal neuroendocrine neoplasms (NETs) are rare diseases usually managed by endoscopic treatment. Although several endoscopic techniques are available, the number of patients with incomplete (R1) resection is significant. AREAS COVERED This review focuses on the meaning of incomplete R1 findings after endoscopic resection in type I gastric NETs; nonfunctioning, non-ampullary duodenal NETs; and small rectal NETs. Data were identified by MEDLINE database search without publication date limitation. EXPERT OPINION An incomplete R1 finding may have no significant impact on a patient's clinical outcome, particularly in small G1 type I gastric NETs, which have an indolent course. A 'stepwise approach,' which uses more advanced endoscopic techniques, or minimally invasive surgery may be justified to achieve complete margin-free resection. This approach must balance the tumor features and the procedure-related risk of complications, particularly in the duodenum, where the role of deep endoscopic resections is limited due to the thin duodenal wall. Gastric and rectal NETs that are incompletely removed after initial resection are more easily amenable to deep endoscopic techniques. However, this might not be necessary for patients with comorbidities, elderly, or both due to the uncertainty of how R1 finding impacts a patient's clinical outcome.
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Affiliation(s)
- Gianluca Esposito
- ENETS Center of ExcellenceDepartment of Medical-Surgical Sciences, Translational Medicine Sapienza University of Rome, Digestive Disease Unit - Sant'andrea University Hospital, Rome, Italy
| | - Elisabetta Dell'Unto
- ENETS Center of ExcellenceDepartment of Medical-Surgical Sciences, Translational Medicine Sapienza University of Rome, Digestive Disease Unit - Sant'andrea University Hospital, Rome, Italy
| | - Irene Ligato
- ENETS Center of ExcellenceDepartment of Medical-Surgical Sciences, Translational Medicine Sapienza University of Rome, Digestive Disease Unit - Sant'andrea University Hospital, Rome, Italy
| | - Matteo Marasco
- ENETS Center of ExcellenceDepartment of Medical-Surgical Sciences, Translational Medicine Sapienza University of Rome, Digestive Disease Unit - Sant'andrea University Hospital, Rome, Italy
| | - Francesco Panzuto
- ENETS Center of ExcellenceDepartment of Medical-Surgical Sciences, Translational Medicine Sapienza University of Rome, Digestive Disease Unit - Sant'andrea University Hospital, Rome, Italy
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10
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Jin R, Bai X, Xu T, Wu X, Wang Q, Li J. Comparison of the efficacy of endoscopic submucosal dissection and transanal endoscopic microsurgery in the treatment of rectal neuroendocrine tumors ≤ 2 cm. Front Endocrinol (Lausanne) 2023; 13:1028275. [PMID: 36704035 PMCID: PMC9873240 DOI: 10.3389/fendo.2022.1028275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Currently, complete tumor resection is considered the most effective treatment for rectal neuroendocrine tumors (NETs). Endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) are recommended for rectalNETs ≤2 cm, but it is not clear which method is better. Thus, we evaluated the efficacy of ESD and TEM in the treatment of rectal neuroendocrine tumors (NETs) ≤ 2 cm. METHODS We conducted a single-centre retrospective cohort study between 2010 and 2021 of rectal NETs ≤ 2 cm in 114 patients with long-term follow-up data who were divided into ESD (n=55) and TEM groups (n=59). Our study assessed differences between groups in the complete resection rate of lesions, recurrence rate, surgical complications, procedure time, and length of hospital stay. RESULTS The co-primary outcomes were the complete resection rate of lesions and the recurrence rate. Compared to that in the ESD group, the complete resection rate was significantly higher in the TEM group (91.5% vs. 70.9%, p=0.005). The median follow-up time was 22 months in our study, and the follow-up outcomes suggested that the rates of recurrence were 1.8% (1/55) and 6.8% (4/59) in the ESD and TEM groups, respectively, with no significant difference between the two groups. The secondary outcomes of the evaluation were surgical complications, procedural time, and length of hospital stay. The rate of complications (gastrointestinal bleeding and perforation) was low in both the ESD (7.3%, 4/55) and TEM (5.1%, 3/59) groups. No difference in hospitalization duration was observed between the two groups in our study. However, the procedure time was significantly shorter in the ESD group than in the TEM group (27.5 min vs. 56 min, p<0.001). CONCLUSIONS Although the rate of complete resection in the TEM group was higher than that in the ESD group, there was no difference in recurrence rates between the two modalities during long-term follow-up. Depending on the qualities of the available hospital resources in the area, one of the two approaches can be adopted.
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Affiliation(s)
- Rui Jin
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoyin Bai
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Tianming Xu
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Gut Microbiota Translational Medicine Research, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xi Wu
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qipu Wang
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Gut Microbiota Translational Medicine Research, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingnan Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Gut Microbiota Translational Medicine Research, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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11
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Zhuang X, Zhang S, Chen G, Luo Z, Hu H, Huang W, Guo Y, Ouyang Y, Peng L, Qing Q, Chen H, Li B, Chen J, Wang X. Risk factors and clinical outcomes of incomplete endoscopic resection of small rectal neuroendocrine tumors in southern China: a 9-year data analysis. Gastroenterol Rep (Oxf) 2022; 11:goac084. [PMID: 36632622 PMCID: PMC9825708 DOI: 10.1093/gastro/goac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/07/2022] [Accepted: 11/29/2022] [Indexed: 01/09/2023] Open
Abstract
Background The histologically complete resection (CR) rate of small rectal neuroendocrine tumors (RNETs) is unsatisfactory at the first endoscopy. Risk factors and clinical outcomes associated with incomplete resection (IR) have not been explicitly elucidated. This study aims to explore the relevant factors of IR. Methods This retrospective study reviewed patients with small RNETs (≤10 mm) in eight centers from January 2013 to December 2021. Clinicopathological characteristics and clinical outcomes were compared between the CR and IR groups, and the polypectomy and advanced treatment groups. Results Of the 326 patients included, 83 (25.5%) were diagnosed with IR. Polypectomy (odds ratio [OR] = 16.86), a central depression (OR = 7.50), and treatment in the early period (OR = 2.60) were closely associated with IR. Further analysis revealed that an atypical hyperemic appearance (OR = 7.49) and treatment in the early period (OR = 2.54) were significantly associated with the inappropriate use of polypectomy (both P < 0.05). In addition, a total of 265 (81.3%) were followed up with a median follow-up period of 30.9 months. No death, metastasis, or recurrence was found during the follow-up period. Conclusions Polypectomy, a central depression, and treatment in the early period were risk factors for IR. Further, an atypical hyperemic appearance and treatment in the early period were significant predisposing factors for inappropriate choice of polypectomy. For histologically incompletely resected small RNETs, follow-up may be a safe and feasible alternative to rigorous salvage therapy.
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Affiliation(s)
| | | | - Guiquan Chen
- Department of Gastroenterology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, P. R. China
| | - Zongqi Luo
- Department of Gastroenterology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, P. R. China
| | - Huiqin Hu
- Department of Gastroenterology, Huizhou First Hospital, Huizhou, P. R. China
| | - Wenfeng Huang
- Department of Gastroenterology, Huizhou First Hospital, Huizhou, P. R. China
| | - Yu Guo
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Yongwen Ouyang
- Department of Digestive Diseases, The First People's Hospital of Foshan, Foshan, P. R. China
| | - Liang Peng
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, P. R. China
| | - Qing Qing
- Department of Gastroenterology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, P. R. China
| | - Huiting Chen
- Department of Gastroenterology and Hepatology, Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, P. R. China
| | - Bingsheng Li
- Corresponding authors. Bingsheng Li, Department of Gastroenterology, Huizhou First Hospital, Huizhou 516000, P. R. China. Tel: +86-752-2883877; ; Jie Chen, Department of Head & Neck Tumors and Neuroendocrine Tumors, Fudan University Shanghai Cancer Center, Shanghai 200032, P. R. China. Tel: +86-21-64175590; ; Xinying Wang, Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, 253 Industrial Road, Haizhu District, Guangzhou 510000, P. R. China. Tel: +86-20-62782273;
| | - Jie Chen
- Corresponding authors. Bingsheng Li, Department of Gastroenterology, Huizhou First Hospital, Huizhou 516000, P. R. China. Tel: +86-752-2883877; ; Jie Chen, Department of Head & Neck Tumors and Neuroendocrine Tumors, Fudan University Shanghai Cancer Center, Shanghai 200032, P. R. China. Tel: +86-21-64175590; ; Xinying Wang, Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, 253 Industrial Road, Haizhu District, Guangzhou 510000, P. R. China. Tel: +86-20-62782273;
| | - Xinying Wang
- Corresponding authors. Bingsheng Li, Department of Gastroenterology, Huizhou First Hospital, Huizhou 516000, P. R. China. Tel: +86-752-2883877; ; Jie Chen, Department of Head & Neck Tumors and Neuroendocrine Tumors, Fudan University Shanghai Cancer Center, Shanghai 200032, P. R. China. Tel: +86-21-64175590; ; Xinying Wang, Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, 253 Industrial Road, Haizhu District, Guangzhou 510000, P. R. China. Tel: +86-20-62782273;
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12
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Liu Z, Zheng C, Ding S, Chen C, Yang J, Wu R, Sun D. EMR-P for small rectal neuroendocrine tumors: is it a preferred treatment? Scand J Gastroenterol 2022; 57:1503-1508. [PMID: 35758188 DOI: 10.1080/00365521.2022.2090854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The selection of endoscopic treatments for small rectal neuroendocrine tumors is controversial. OBJECTIVE To retrospectively compare the effectiveness and safety of precut endoscopic mucosal resection (EMR-P) and endoscopic submucosal dissection (ESD) for small rectal neuroendocrine tumors (NETs). METHODS Data from 98 patients with small rectal NETs who were hospitalized at Shenzhen Second People's Hospital between August 2014 and November 2021 were collected. The en bloc resection rate, pathological complete resection rate, radical resection rate, operation time, adverse event rate and hospital stay were compared between the two groups. RESULTS The operation time in the EMR-P group was significantly shorter than that in the ESD group. The median hospital stay in the EMR-P group was also significantly shorter than that in the ESD group. There were no significant differences between the two groups in terms of the en bloc resection, complete resection or radical resection rates. There was also no significant difference in the incidence of adverse events between the two groups. The delayed bleeding and delayed perforation rates of the two groups were improved after conservative treatment without surgery. There was no significant difference in the rate of positive vertical margins and horizontal margins between the EMR-P group and the ESD group. No local recurrence or metastasis was found during follow-up. CONCLUSION EMR-P is an effective and safe endoscopic treatment for rectal NETs with a diameter of less than 10 mm. EMR-P is a significantly shorter procedure and requires a shorter hospital stay than ESD. EMR-P does not increase the cut margin positivity rate.
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Affiliation(s)
- Zhaohui Liu
- The Department of Gastroenterology, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Chunsi Zheng
- The Department of Gastroenterology, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Shihua Ding
- The Department of Gastroenterology, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Chong Chen
- The Department of Gastroenterology, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Jingbo Yang
- The Department of Gastroenterology, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Ruinuan Wu
- The Department of Pathology, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Dayong Sun
- The Department of Gastroenterology, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
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13
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Cha B, Shin J, Ko WJ, Kwon KS, Kim H. Prognosis of incompletely resected small rectal neuroendocrine tumor using endoscope without additional treatment. BMC Gastroenterol 2022; 22:293. [PMID: 35681149 PMCID: PMC9185951 DOI: 10.1186/s12876-022-02365-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In recent years, the incidence of rectal neuroendocrine tumors (NET)s has markedly increased due to the widespread use of screening colonoscopy. However, many patients are referred from local clinics after undergoing conventional endoscopic mucosal resection (EMR) for polyps without perceived NET, with a pathological report of incomplete resection. We evaluated the prognosis of incompletely resected small rectal NET without additional endoscopic resection for small rectal NET less than 10 mm in diameter present within the submucosal layer showing good prognosis, due to its rare metastatic potential. METHODS We retrospectively reviewed patients from 2008 to 2018 at a single center who had had small rectal NET (located in the rectum from the anal verge to 20 cm in proximity) and had undergone 'incomplete resection' using endoscopy with a positive deep margin or with a very small safe deep margin (< 100 um). A small rectal NET was defined as a tumor ≤ 10 mm in diameter, without lymph node nor distant metastasis, and with low grade (G1) according to the WHO grading system. RESULTS Of 267 patients who were diagnosed with small rectal NET, 77 were diagnosed with incomplete resection or possible remnant NET. Of those, 55 patients (55/77, 71.4%) were referred from local clinics post EMR diagnosed as polyps. The rate of histologically incomplete resection was highest in endoscopic submucosal dissection (11/21, 52.4%) and lowest in surgical resection (0/9, 0%), while endoscopic submucosal resection with band ligation showed an incomplete resection rate of 4.4% (5/113). After exclusion of 36 patients, namely 21 patients had undergone additional surgical (n = 6) or endoscopic (n = 15) resection and 25 patients who were lost during the follow-up period of 2 years, 31 patients had undergone surveillance with endoscopic evaluation or either a biopsy or radiological evaluation for distant metastasis during a median follow-up duration of 2 years. None of the incompletely resected small rectal NET patients showed local or distant metastasis. CONCLUSION Incomplete resection of small rectal NET with G1 grade has a good prognosis without additional treatment.
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Affiliation(s)
- Boram Cha
- Department of Internal Medicine, Digestive Disease Center, Inha University School of Medicine, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon, 400-711, Republic of Korea
| | - Jongbeom Shin
- Department of Internal Medicine, Digestive Disease Center, Inha University School of Medicine, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon, 400-711, Republic of Korea
| | - Weon Jin Ko
- Department of Internal Medicine, Digestive Disease Center, Inha University School of Medicine, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon, 400-711, Republic of Korea
| | - Kye Sook Kwon
- Department of Internal Medicine, Digestive Disease Center, Inha University School of Medicine, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon, 400-711, Republic of Korea
| | - Hyungkil Kim
- Department of Internal Medicine, Digestive Disease Center, Inha University School of Medicine, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon, 400-711, Republic of Korea.
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14
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Pattarajierapan S, Khomvilai S. Recurrence after endoscopic resection of small rectal neuroendocrine tumors: a retrospective cohort study. Ann Coloproctol 2022; 38:216-222. [PMID: 34280965 PMCID: PMC9263308 DOI: 10.3393/ac.2021.00017.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/15/2022] Open
Abstract
PURPOSE According to the European Neuroendocrine Tumor Society consensus guidelines, rectal neuroendocrine tumors (NETs) up to 10 mm in size and without poor prognostic factors could be safely removed with endoscopic resection, suggesting omitting surveillance colonoscopy after complete resection. However, the benefit of surveillance colonoscopy is still unknown. In this study, we aimed to report the outcomes after endoscopic resection of small rectal NETs using our surveillance protocol. METHODS This retrospective cohort study included patients who underwent endoscopic resection for rectal NETs sized up to 10 mm from January 2013 to December 2019 at our center. We excluded patients without surveillance colonoscopy and those lost to follow-up. We strictly performed surveillance colonoscopy 1 year after endoscopic resection, and every 2 to 3 years thereafter. The primary outcomes were tumor recurrence and occurrence of metachronous tumors during followup. RESULTS Of the 54 patients who underwent endoscopic resection for rectal NETs during the study period, 46 were enrolled in this study. The complete resection rates by endoscopic mucosal resection, precutting endoscopic mucosal resection, and endoscopic submucosal dissection were 92.3% (12 of 13), 100% (21 of 21), and 100% (12 of 12), respectively. There was no local or distant recurrence during the median follow-up of 39 months. However, we found that 8.7% (4 of 46) of patients developed metachronous NETs. All metachronous lesions were treated with precutting endoscopic mucosal resection. CONCLUSION Surveillance colonoscopy is reasonable after endoscopic resection of small rectal NETs for timely detection and treatment of metachronous lesions. However, larger collaborative studies are needed to influence the guidelines.
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Affiliation(s)
- Sukit Pattarajierapan
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Supakij Khomvilai
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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15
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Weng Y, Ran J, Peng Y, Xiang Y, Xu L. Comparison of characteristics between true rectal neuroendocrine tumors and rectal hyperplastic polyps among patients with endoscope-diagnosed rectal neuroendocrine tumors. J Gastrointest Oncol 2022; 13:1121-1131. [PMID: 35837162 PMCID: PMC9274043 DOI: 10.21037/jgo-22-369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background To explore the white light endoscopy and endoscopic ultrasonography (EUS) features of rectal hyperplastic polyps (rHP) misdiagnosed as rectal neuroendocrine neoplasms (rNENs). In rNENs with a diameter of 5-10 mm, the endoscopic findings are not typical and some of them are similar to rHP, so it is not uncommon to misdiagnose rNENs as rHP. However, misdiagnosis of rHP as rNENs has not been reported in the literature, which can alert clinicians to the existence of this possibility and avoid over-treatment. Methods We collected 245 cases of rectal submucosal tumor (SMT) diagnosed by endoscopy in our hospital from January 2015 to December 2020 and 103 patients with suspected rNENs identified through endoscopy. A retrospective analysis was conducted of the shape, color, vascular dilatation, and boundary on the surface of the lesion under white light endoscope, and the source, boundary, and echo characteristics of EUS. We also analyzed the endoscopic features of rHP misdiagnosed as rNENs. Endoscopic diagnosis and pathological diagnosis were reviewed by a senior endoscopic expert and pathologist respectively. The counting data were tested and analyzed by χ2 test and Fisher exact probability method. Results A total of 103 cases of rNENs were diagnosed by endoscope, among whom 75 cases were confirmed as rNENs (72.8%) and 8 cases as rHP (7.8%) by histopathology. There was no significant difference between rNENs and rHP in terms of gender, age, clinical manifestation, shape and color of lesions, dilatation of blood vessels on the surface, and location of lesions. Meanwhile, there were significant differences in whether the boundary of the lesion was clear under white light endoscopy, and the source, echo, and boundary of the lesion under EUS. Conclusions The morphology of some rHP is similar to rNENs under endoscopy. The boundary is clear under white light endoscopy and the source, echo, and boundary under EUS are helpful for the diagnosis of rNENs and rHP.
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Affiliation(s)
- Yan Weng
- Clinical College of Guiyang Medical University, Guiyang, China
| | - Jingxue Ran
- Clinical College of Guiyang Medical University, Guiyang, China
| | - Yongmei Peng
- Clinical College of Guiyang Medical University, Guiyang, China
| | - Yining Xiang
- Department of Pathology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Liangbi Xu
- Endoscopy Center of the Affiliated Hospital of Guizhou Medical University, Guiyang, China
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16
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Ricci AD, Pusceddu S, Panzuto F, Gelsomino F, Massironi S, De Angelis CG, Modica R, Ricco G, Torchio M, Rinzivillo M, Prinzi N, Rizzi F, Lamberti G, Campana D. Assessment of the Risk of Nodal Involvement in Rectal Neuroendocrine Neoplasms: The NOVARA Score, a Multicentre Retrospective Study. J Clin Med 2022; 11:713. [PMID: 35160165 PMCID: PMC8836953 DOI: 10.3390/jcm11030713] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 02/05/2023] Open
Abstract
Rectal neuroendocrine tumors (r-NETs) are rare tumors with overall good prognosis after complete resection. However, there is no consensus on the extension of lymphadenectomy or regarding contraindications to extensive resection. In this study, we aim to identify predictive factors that correlate with nodal metastasis in patients affected by G1-G2 r-NETs. A retrospective analysis of G1-G2 r-NETs patients from eight tertiary Italian centers was performed. From January 1990 to January 2020, 210 patients were considered and 199 were included in the analysis. The data for nodal status were available for 159 cases. The nodal involvement rate was 9%. A receiver operating characteristic (ROC) curve analysis was performed to identify the diameter (>11.5 mm) and Ki-67 (3.5%), respectively, as cutoff values to predict nodal involvement. In a multivariate analysis, diameter > 11.5 mm and vascular infiltration were independently correlated with nodal involvement. A risk scoring system was constructed using these two predictive factors. Tumor size and vascular invasion are predictors of nodal involvement. In addition, tumor size > 11.5 mm is used as a driving parameter of better-tailored treatment during pre-operative assessment. Data from prospective studies are needed to validate these results and to guide decision-making in r-NETs patients in clinical practice.
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Affiliation(s)
- Angela Dalia Ricci
- Department of Experimental, Diagnostic and Specialty Medicine, Sant’Orsola-Malpighi University Hospital, ENETS Center of Excellence, 40138 Bologna, Italy; (A.D.R.); (G.R.); (D.C.)
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via P. Albertoni 15, 40138 Bologna, Italy
| | - Sara Pusceddu
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori Milano, ENETS Center of Excellence, 20133 Milan, Italy; (S.P.); (M.T.); (N.P.)
| | - Francesco Panzuto
- Digestive Disease Unit, Sant’Andrea University Hospital, ENETS Center of Excellence of Rome, 00189 Rome, Italy; (F.P.); (M.R.)
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Fabio Gelsomino
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, 41125 Modena, Italy;
| | - Sara Massironi
- Division of Gastroenterology, Department of Medicine and Surgery, University of Milano-Bicocca, San Gerardo School of Medicine, 20900 Monza, Italy;
| | - Claudio Giovanni De Angelis
- Department of Gastroenterology and Digestive Endoscopy, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (C.G.D.A.); (F.R.)
| | - Roberta Modica
- Endocrinology, Department of Clinical Medicine and Surgery, ENETS Center of Excellence, University “Federico II” of Naples, 80138 Naples, Italy;
| | - Gianluca Ricco
- Department of Experimental, Diagnostic and Specialty Medicine, Sant’Orsola-Malpighi University Hospital, ENETS Center of Excellence, 40138 Bologna, Italy; (A.D.R.); (G.R.); (D.C.)
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via P. Albertoni 15, 40138 Bologna, Italy
| | - Martina Torchio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori Milano, ENETS Center of Excellence, 20133 Milan, Italy; (S.P.); (M.T.); (N.P.)
| | - Maria Rinzivillo
- Digestive Disease Unit, Sant’Andrea University Hospital, ENETS Center of Excellence of Rome, 00189 Rome, Italy; (F.P.); (M.R.)
| | - Natalie Prinzi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori Milano, ENETS Center of Excellence, 20133 Milan, Italy; (S.P.); (M.T.); (N.P.)
| | - Felice Rizzi
- Department of Gastroenterology and Digestive Endoscopy, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (C.G.D.A.); (F.R.)
| | - Giuseppe Lamberti
- Department of Experimental, Diagnostic and Specialty Medicine, Sant’Orsola-Malpighi University Hospital, ENETS Center of Excellence, 40138 Bologna, Italy; (A.D.R.); (G.R.); (D.C.)
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via P. Albertoni 15, 40138 Bologna, Italy
| | - Davide Campana
- Department of Experimental, Diagnostic and Specialty Medicine, Sant’Orsola-Malpighi University Hospital, ENETS Center of Excellence, 40138 Bologna, Italy; (A.D.R.); (G.R.); (D.C.)
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via P. Albertoni 15, 40138 Bologna, Italy
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Fu ZY, Kmeid M, Aldyab M, Lagana SM, Lee H. Composite intestinal adenoma-microcarcinoid: An update and literature review. World J Gastrointest Endosc 2021; 13:593-606. [PMID: 35070021 PMCID: PMC8716980 DOI: 10.4253/wjge.v13.i12.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 10/19/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
Composite intestinal adenoma-microcarcinoid (CIAM) is a rare intestinal lesion consisting of conventional adenoma and small, well differentiated carcinoid [microcarcinoid (MC)] at its base. The incidence of CIAM is 3.8% in surgically resected colorectal polyps. While its pathogenesis is unknown, studies support the role of Wnt/β-catenin pathway in the tumorigenesis of CIAM. CIAMs have been primarily reported in the colon wherein they present as polyps with well-defined margins, similar to conventional adenomatous polyps. MC is usually found in adenomatous polyps with high-risk features such as large size, villous architecture, or high grade dysplasia. Histologically, the MC component is often multifocal and spans 3.9 to 5.8 millimeters in size. MC is usually confined within the mucosa but occasional CIAM cases with MC extending to the submucosa have been reported. MC of CIAM demonstrates bland cytology and inconspicuous proliferative activity. The lesional cells are positive for synaptophysin and 60% to 100% of cases show nuclear β-catenin positivity. MC poses a diagnostic challenge with its morphologic and immunohistochemical resemblance to both benign and malignant lesions, including squamous morules/metaplasia, adenocarcinoma, squamous cell carcinoma, sporadic neuroendocrine tumor and goblet cell adenocarcinoma. CIAM is an indolent lesion with a favorable outcome. Complete removal by polypectomy is considered curative. Awareness and recognition of this rare entity will help arrive at correct diagnosis and improve patient care. Currently, CIAM is not recognized as a subtype of mixed neuroendocrine-non-neuroendocrine neoplasm by WHO.
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Affiliation(s)
- Zhi-Yan Fu
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY 12208, United States
| | - Michel Kmeid
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY 12208, United States
| | - Mahmoud Aldyab
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY 12208, United States
| | - Stephen M Lagana
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Hwajeong Lee
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY 12208, United States
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18
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Carvão J, Dinis-Ribeiro M, Pimentel-Nunes P, Libânio D. Neuroendocrine Tumors of the Gastrointestinal Tract: A Focused Review and Practical Approach for Gastroenterologists. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 28:336-348. [PMID: 34604465 PMCID: PMC8443956 DOI: 10.1159/000512089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/01/2020] [Indexed: 02/05/2023]
Abstract
Neuroendocrine tumors (NETs) are rare tumors derived from the neuroendocrine cell system, and more commonly found in the gastrointestinal (GI) tract. Over the last decades, the incidence of GI-NETs has been steadily increasing, partly due to the expanding indications for endoscopy. Most patients with NETs are asymptomatic, and their NETs are noticed during screening examinations; thus, endoscopists are on the frontline of the diagnosis of GI-NETs. Since GI-NETs are less frequent than other malignancies, the natural history, diagnosis, and management of these tumors may not be fully understood. In this review, we aim to update the endoscopist on key clinical features and management of patients with gastric, duodenal, and rectal NETs.
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Affiliation(s)
- Joana Carvão
- Gastroenterology Department, Hospital Central do Funchal, Funchal, Portugal
| | - Mário Dinis-Ribeiro
- Gastroenterology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
- MEDCIDS − Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Gastroenterology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
- MEDCIDS − Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
- Surgery and Physiology Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Diogo Libânio
- Gastroenterology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
- MEDCIDS − Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
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19
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Park SS, Kim BC, Lee DE, Han KS, Kim B, Hong CW, Sohn DK. Comparison of endoscopic submucosal dissection and transanal endoscopic microsurgery for T1 rectal neuroendocrine tumors: a propensity score-matched study. Gastrointest Endosc 2021; 94:408-415.e2. [PMID: 33600807 DOI: 10.1016/j.gie.2021.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/09/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) are the most effective endoscopic resection methods for T1 rectal neuroendocrine tumors (NETs). We aimed to compare the efficacy and safety of ESD and TEM for rectal NETs ≤20 mm. METHODS Patients with rectal NETs ≤20 mm who underwent ESD or TEM were enrolled in this retrospective observational study. ESD and TEM groups were matched for pathologic tumor size and EMR history. We evaluated between-group differences in R0 resection rate, adverse event rate, procedure time, and hospital stay. RESULTS We included 285 patients (ESD = 226, TEM = 59) in the final cohort, with 104 patients in the matched groups (ESD = 52, TEM = 52). The R0 resection rate was significantly higher for TEM (ESD 71.2% vs TEM 92.3%, P = .005). However, the median procedure time (ESD 22 [range, 11-65] vs TEM 35 [17-160] minutes, P < .001) and hospital stay (ESD 2.5 range 1-5] vs TEM 4 [3-8] days, P < .001) were significantly shorter for ESD. In the subgroup analysis of patients divided by tumor size <10 mm (ESD = 218, TEM = 49) and 10 to 20 mm (ESD = 8, TEM = 10)], there was no significant between-group difference in the R0 resection rate (83.5% vs 93.9%, P = .063 and 37.5% vs 80%, P = .145, respectively) or the rate of recurrence. CONCLUSIONS Although TEM showed a better overall R0 resection rate for rectal NETs ≤20 mm, ESD could be a viable treatment modality concerning adverse events, procedure time, and hospital stay for rectal NETs <10 mm with similar R0 resection rates in comparison with TEM.
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Affiliation(s)
- Sung Sil Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Byung Chang Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Dong-Eun Lee
- Biostatistics Collaboration Team, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Kyung Su Han
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Bun Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Chang Won Hong
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Dae Kyung Sohn
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
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20
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Kim J, Kim J, Oh EH, Ham NS, Hwang SW, Park SH, Ye BD, Byeon JS, Myung SJ, Yang SK, Hong SM, Yang DH. Anchoring the snare tip is a feasible endoscopic mucosal resection method for small rectal neuroendocrine tumors. Sci Rep 2021; 11:12918. [PMID: 34155319 PMCID: PMC8217176 DOI: 10.1038/s41598-021-92462-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/08/2021] [Indexed: 12/15/2022] Open
Abstract
Small rectal neuroendocrine tumors (NETs) can be treated using cap-assisted endoscopic mucosal resection (EMR-C), which requires additional effort to apply a dedicated cap and snare. We aimed to evaluate the feasibility of a simpler modified endoscopic mucosal resection (EMR) technique, so-called anchored snare-tip EMR (ASEMR), for the treatment of small rectal NETs, comparing it with EMR-C. We retrospectively evaluated 45 ASEMR and 41 EMR-C procedures attempted on small suspected or established rectal NETs between July 2015 and May 2020. The mean (SD) lesion size was 5.4 (2.2) mm and 5.2 (1.7) mm in the ASEMR and EMR-C groups, respectively (p = 0.558). The en bloc resection rates of suspected or established rectal NETs were 95.6% (43/45) and 100%, respectively (p = 0.271). The rates of histologic complete resection of rectal NETs were 94.1% (32/34) and 88.2% (30/34), respectively (p = 0.673). The mean procedure time was significantly shorter in the ASEMR group than in the EMR-C group (3.12 [1.97] vs. 4.13 [1.59] min, p = 0.024). Delayed bleeding occurred in 6.7% (3/45) and 2.4% (1/41) of patients, respectively (p = 0.618). In conclusion, ASEMR was less time-consuming than EMR-C, and showed similar efficacy and safety profiles. ASEMR is a feasible treatment option for small rectal NETs.
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Affiliation(s)
- Jeongseok Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.,Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jisup Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Hye Oh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.,Department of Gastroenterology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Nam Seok Ham
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Sung Wook Hwang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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21
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Maione F, Chini A, Milone M, Gennarelli N, Manigrasso M, Maione R, Cassese G, Pagano G, Tropeano FP, Luglio G, De Palma GD. Diagnosis and Management of Rectal Neuroendocrine Tumors (NETs). Diagnostics (Basel) 2021; 11:771. [PMID: 33923121 PMCID: PMC8145857 DOI: 10.3390/diagnostics11050771] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 12/15/2022] Open
Abstract
Rectal neuroendocrine tumors (NETs) are rare, with an incidence of 0.17%, but they represent 12% to 27% of all NETs and 20% of gastrointestinal NETs. Although rectal NETs are uncommon tumors, their incidence has increased over the past few years, and this is probably due to the improvement in detection rates made by advanced endoscopic procedures. The biological behavior of rectal NETs may be different: factors predicting the risk of metastases have been identified, such as size and grade of differentiation. The tendency for metastatic diffusion generally depends on the tumor size, muscular and lymphovascular infiltration, and histopathological differentiation. According to the current European Neuroendocrine Tumor Society (ENETS) guidelines, tumors that are smaller than 10 mm and well differentiated are thought to have a low risk of lymphovascular invasion, and they should be completely removed endoscopically. Rectal NETs larger than 20 mm have a higher risk of involvement of muscularis propria and high metastatic risk and are candidates for surgical resection. There is controversy over rectal NETs of intermediate size, 10-19 mm, where the metastatic risk is considered to be 10-15%: assessment of tumors endoscopically and by endoanal ultrasound should guide treatment in these cases towards endoscopic, transanal, or surgical resection.
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Affiliation(s)
- Francesco Maione
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (M.M.); (N.G.); (M.M.); (R.M.); (G.C.); (G.P.); (F.P.T.); (G.L.); (G.D.D.P.)
| | - Alessia Chini
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (M.M.); (N.G.); (M.M.); (R.M.); (G.C.); (G.P.); (F.P.T.); (G.L.); (G.D.D.P.)
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22
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Chung HG, Goh MJ, Kim ER, Hong SN, Kim TJ, Chang DK, Kim YH. Recurrence pattern and surveillance strategy for rectal neuroendocrine tumors after endoscopic resection. J Gastroenterol Hepatol 2021; 36:968-973. [PMID: 32864790 DOI: 10.1111/jgh.15231] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/06/2020] [Accepted: 08/21/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Endoscopic resection is highly effective treatment option for rectal neuroendocrine tumors (NETs) as they usually present as small localized tumors. However, there are no well-established surveillance strategies following endoscopic resection. We established our own protocol for the surveillance of rectal NETs after endoscopic resection since 2013. This study aimed to assess the outcome and to optimize the surveillance strategies after endoscopic resection. METHODS We retrospectively analyzed the data of patients with endoscopically treated rectal NETs between January 2013 and April 2018 at Samsung Medical Center. We analyzed 337 patients with a median follow-up duration of 35.0 months (min-max: 12.0-88.3). RESULTS A total of 329 (97.6%) patients had tumors ≤ 1 cm in size, and eight (2.4%) patients had tumors > 1 cm in diameter. Synchronous rectal NETs were diagnosed in nine (2.7%) patients. Thirteen (3.9%) patients were identified as having positive resection margins. Regardless of the salvage treatment, none of these patients developed recurrence. Metachronous rectal NETs were diagnosed in nine (2.7%) patients. Metachronous lesions were associated with the number of synchronous lesions at initial diagnosis (P < 0.001, hazard ratio = 1.75, 95% confidence interval = 1.38-2.23). Extracolonic metastasis was not detected in this study. CONCLUSION Although initial screening for detecting metastatic lesions using computed tomography is recommended, repeated imaging for detecting extracolonic recurrence was not necessary for small non-metastatic rectal NETs. However, regular endoscopic follow-up seems reasonable, especially in case of synchronous rectal NETs, for detecting metachronous rectal NETs.
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Affiliation(s)
- Hye Gyo Chung
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Myung Ji Goh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Eun Ran Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung Noh Hong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Tae Jun Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong Kyung Chang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Ho Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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23
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Sappenfield R, Gonzalez IA, Cao D, Chatterjee D. Well-differentiated rectal neuroendocrine tumors: analysis of histology, including insulinoma-associated protein 1 expression, and biologic behavior, involving a large cohort of 94 cases. Hum Pathol 2020; 104:66-72. [PMID: 32763255 DOI: 10.1016/j.humpath.2020.07.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/16/2020] [Accepted: 07/23/2020] [Indexed: 12/31/2022]
Abstract
Well-differentiated rectal neuroendocrine tumors (R-NETs) are increasingly being detected by screening colonoscopy, commonly manifesting as polyps. Chromogranin A is frequently negative in R-NETs. Insulinoma-associated protein 1 (INSM1) is a novel transcription factor that has recently shown excellent sensitivity and specificity for neuroendocrine (NE) differentiation in various anatomic sites but has not been systematically evaluated in R-NET. A retrospective histologic review of all available R-NETs was performed and stained for INSM1 immunohistochemistry, as well as for Ki-67 and chromogranin A, if not already available. Clinical and follow-up information was obtained from the medical chart. A total of 94 R-NETs were included in our cohort. Of these, 82 (87%) were <10 mm in greatest dimension, and submucosal involvement was noted in 70 patients (74%). The tumors displayed a variety of histologic patterns, and the majority of the cases had intratumoral fibrosis (61%). Synaptophysin and INSM1 were reactive in 100% cases, whereas chromogranin A was reactive in 45% cases. The mean Ki-67 proliferative index was 1.6% (range: 0.5-5%). The median follow-up of the cohort was 30 months (80 cases, range: 3-226 months). Only three patients were identified with regional lymph node metastasis, all of which showed a tumor size ≥10 mm and had lymphovascular invasion (LVI). R-NETs in our fairly large cohort display an indolent biologic behavior without distant metastasis. Metastatic disease in lymph nodes was associated with tumor size and the presence of LVI, but not with the Ki-67 proliferative index. This is also the first systematic study documenting INSM1 as a highly sensitive NE marker in R-NET.
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Affiliation(s)
- Ryan Sappenfield
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - Ivan A Gonzalez
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - Dengfeng Cao
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - Deyali Chatterjee
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, 63110, USA.
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24
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Chida K, Watanabe J, Hirasawa K, Inayama Y, Misumi T, Kunisaki C, Endo I. A novel risk-scoring system for predicting lymph node metastasis of rectal neuroendocrine tumors. Ann Gastroenterol Surg 2020; 4:562-570. [PMID: 33005851 PMCID: PMC7511567 DOI: 10.1002/ags3.12355] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 01/02/2023] Open
Abstract
AIM Although rectal neuroendocrine tumors (NETs) are considered to be rare low-grade malignancies when lymph node metastasis (LNM) is present, their degree of malignancy is comparable to that of colorectal cancer (CRC). However, it remains unclear as to which patients require radical lymph node dissection. The aim of this study was to elucidate the risk factors for LNM and develop a risk-scoring system for LNM to help determine appropriate therapeutic approaches. METHODS In this study, we examined 103 patients with rectal NETs who underwent local resection (n = 55) or radical resection with LN dissection (n = 48). We evaluated each pathological feature, including the depth of submucosal invasion (SM depth) and tumor budding grade. RESULTS According to our univariate analyses and previous reports, the significant five risk factors for LNM were weighted with point values: 2 points for tumor size ≥ 15 mm and muscularis invasion, and 1 point each for SM depth ≥ 2000 µm, positive lymphovascular invasion, budding grade 3, and vertical margin. The area under the receiver operating curve for the scoring system was 0.899 (95% CI: 0.843-0.955). When a score of 2 was used as the cut-off value, the sensitivity and specificity for the prediction of LNM were 100% and 72.1%, respectively. CONCLUSIONS The risk-scoring system for LNM of rectal NETs showed high diagnostic performance. Using this risk-scoring system, it is possible to predict the risk of LNM and thereby potentially avoid unnecessary surgery. Further prospective external validation studies should be performed. The study was registered in the Japanese Clinical Trials Registry as UMIN000036658.
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Affiliation(s)
- Keigo Chida
- Department of Gastroenterological SurgeryYokohama City University Graduate School of MedicineYokohamaJapan
| | - Jun Watanabe
- Department of SurgeryGastroenterological CenterYokohama City University Medical CenterYokohamaJapan
| | - Kingo Hirasawa
- Division of EndoscopyYokohama City University Medical CenterYokohamaJapan
| | - Yoshiaki Inayama
- Department of PathologyYokohama City University Medical CenterYokohamaJapan
| | - Toshihiro Misumi
- Department of BiostatisticsYokohama City University School of MedicineYokohamaJapan
| | - Chikara Kunisaki
- Department of SurgeryGastroenterological CenterYokohama City University Medical CenterYokohamaJapan
| | - Itaru Endo
- Department of Gastroenterological SurgeryYokohama City University Graduate School of MedicineYokohamaJapan
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25
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Fine C, Roquin G, Terrebonne E, Lecomte T, Coriat R, Do Cao C, de Mestier L, Coffin E, Cadiot G, Nicolli P, Lepiliez V, Hautefeuille V, Ramos J, Girot P, Dominguez S, Céphise FLV, Forestier J, Hervieu V, Pioche M, Walter T. Endoscopic management of 345 small rectal neuroendocrine tumours: A national study from the French group of endocrine tumours (GTE). United European Gastroenterol J 2019; 7:1102-1112. [PMID: 31662867 DOI: 10.1177/2050640619861883] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/13/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction Small rectal neuroendocrine tumours are good candidates for endoscopic resection provided that complete pathological resection (R0) is obtained and their risk of metastatic progression is low. We conducted a large multicentre nationwide study to evaluate the outcomes of the management of non-metastatic rectal neuroendocrine tumours ≤2 cm diagnosed endoscopically. Patients and methods The medical records, the endoscopic and pathological findings of patients with non-metastatic rectal neuroendocrine tumours ≤2 cm managed from January 2000-June 2018 in 16 French hospitals, were retrospectively analysed. The primary objective was to describe the proportion of R0 endoscopic resections. Results A total of 329 patients with 345 rectal neuroendocrine tumours were included, 330 (96%) tumours were managed by local treatments: 287 by endoscopy only and 43 by endoscopy followed by transanal endoscopic microsurgery. The final endoscopic R0 rate was 134/345 (39%), which improved from the first endoscopy (54/225, 24%), to the second (60/100, 60%) and the third endoscopy (20/26, 77%). R0 was associated with endoscopic technique (90% for advanced techniques, 40% for mucosectomy and 17% for polypectomy), but not with tumour or patient characteristics. Twenty patients had metastatic disease, which was associated with tumour size ≥10 mm (odds ratio: 9.1, 95% confidence interval (3.5-23.5)), tumour grade G2-G3 (odds ratio: 4.2, (1.5-11.7)), the presence of muscular (odds ratio: ∞, (11.9-∞)) and lymphovascular invasion (odds ratio: 57.2, (5.6-578.9)). Conclusions The resection of small rectal neuroendocrine tumours often requires multiple procedures. Training of endoscopists is necessary in order to better recognise these tumours and to perform the appropriate resection technique.
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Affiliation(s)
- Caroline Fine
- Service de Gastroentérologie et d'Oncologie Médicale, Hôpital Edouard Herriot, Lyon, France
| | - Guillaume Roquin
- Service de Gastro Entérologie et d'Oncologie Digestive, CHU Angers, Angers, France
| | - Eric Terrebonne
- Service de Gastro Entérologie et d'Oncologie Digestive, CHU de Bordeaux, Bordeaux, France
| | | | - Romain Coriat
- Service de Gastro-Entérologie, Oncologie Digestive, Hôpital Cochin, Paris, France
| | | | - Louis de Mestier
- Service de Gastroentérologie et Pancréatologie, Hôpital Beaujon, Clichy, France
| | - Elise Coffin
- Service de Gastro Entérologie et d'Oncologie Digestive, Hôpital Européen Georges Pompidou, Paris, France
| | - Guillaume Cadiot
- Service de Gastroentérologie et d'Oncologie Digestive, CHRU de Reims, Reims, France
| | - Patricia Nicolli
- Service d'Endocrinologie, Institut Paoli Calmette, Marseille, France
| | - Vincent Lepiliez
- Service de Gastroentérologie et d'Endoscopie, Hopital Privé Jean Mermoz, Lyon, France.,Research and Development Committee, French Society of Digestive Endoscopy, Paris, France
| | | | - Jeanne Ramos
- Service d'Anatomie et Cytologie Pathologiques, CHU - Hôpital Gui de Chauliac, Montpellier, France
| | - Paul Girot
- Service de Gastroentérologie et d'Oncologie Digestive, CHU de Nantes, Nantes, France
| | - Sophie Dominguez
- Service d'Onco-Hématologie, Université Catholique de Lille, Lille, France
| | | | - Julien Forestier
- Service de Gastroentérologie et d'Oncologie Médicale, Hôpital Edouard Herriot, Lyon, France
| | - Valérie Hervieu
- Service Central d'Anatomie et Cytologie Pathologiques, Hôpital Edouard Herriot, Lyon, France
| | - Mathieu Pioche
- Service de Gastroentérologie et d'Oncologie Médicale, Hôpital Edouard Herriot, Lyon, France.,Research and Development Committee, French Society of Digestive Endoscopy, Paris, France.,University of Lyon, Université Lyon 1, Lyon, France
| | - Thomas Walter
- Service de Gastroentérologie et d'Oncologie Médicale, Hôpital Edouard Herriot, Lyon, France.,University of Lyon, Université Lyon 1, Lyon, France
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