Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2025; 17(2): 99906
Published online Feb 16, 2025. doi: 10.4253/wjge.v17.i2.99906
Comparison of endoscopic submucosal dissection and transanal endoscopic microsurgery for stage 1 rectal neuroendocrine tumors
Jun Weng, Jun Chi, Yan-Hua Lv, Ruo-Bing Chen, Guo-Liang Xu, Xian-Feng Xia, Kun-Hao Bai
Jun Weng, Jun Chi, Guo-Liang Xu, Xian-Feng Xia, Kun-Hao Bai, Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Jun Chi, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Yan-Hua Lv, Ruo-Bing Chen, Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Co-first authors: Jun Weng and Jun Chi.
Co-corresponding authors: Xian-Feng Xia and Kun-Hao Bai.
Author contributions: Bai KH and Xia XF designed the research; Weng J, Chi J, Lv YH and Chen RB collected the data and did the analysis; Weng J and Chi J prepared the manuscript draft; Bai KH, Xia XF, and Xu GL provided research support and revised the manuscript; All authors read and approved the final manuscript. Weng J and Chi J contributed equally to this work as co-first authors. Bai KH and Xia XF contributed equally to this work as co-corresponding authors. The reasons are as follows. First, the research was performed as a collaborative effort, and the designation of co-first authors and co-corresponding authors authorship accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the study and the resultant paper. Second, Weng J and Chi J contributed efforts of equal substance for the data analysis and preparing manuscript draft. Bai KH and Xia XF contributed efforts of equal substance for designing the research, preparing manuscript draft, providing research support and revising the manuscript. In summary, we believe that both designating Weng J and Chi J as co-first authors and designating Bai KH and Xia XF as co-corresponding authors are fitting for our manuscript as it accurately reflects our team's collaborative spirit, equal contributions, and diversity.
Supported by the Basic and Applied Basic Research Foundation of Guangzhou, No. 202201011331; the National Natural Science Foundation of China, No. 82373118; and the Natural Science Foundation of Guangdong Province, No. 2023A1515010828.
Institutional review board statement: The study was approved by the Sun Yat-sen University Cancer Center's Institutional Review Board's Ethics Committee (SL-B2023-722-01).
Informed consent statement: All participants were already asked to give signed informed consent before the operation. So, when this retrospective study was checked by the ethics committee, another informed consent was exempt.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data generated or analysed during this study are included in this published article.
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: Kun-Hao Bai, MD, Department of Endoscopy, Sun Yat-sen University Cancer Center, No. 651 Dongfengdong Street, Yuexiu District, Guangzhou 510060, Guangdong Province, China. baikh@sysucc.org.cn
Received: August 2, 2024
Revised: January 8, 2025
Accepted: January 17, 2025
Published online: February 16, 2025
Processing time: 194 Days and 14.5 Hours
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.

Keywords: Rectal neuroendocrine tumors; Endoscopic submucosal dissection; Transanal endoscopic microsurgery; Safety; Efficacy

Core Tip: Few studies have directly compared the results of endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) for rectal neuroendocrine tumors (NETs) ≤ 20 mm in size, and there is still no agreement on which treatment is safer and more effective. This research analyzed 128 Lesions who were diagnosed with rectal NETs and treated with ESD or TEM. We found that both ESD and TEM were safe and effective for local resection of stage 1 rectal NETs, with a more reduced hospital stay and lower overall costs, we also discovered that ESD was more cost-effective than TEM.