Comparison of endoscopic submucosal dissection and transanal endoscopic microsurgery for stage 1 rectal neuroendocrine tumors

Table 1 The characteristics of 128 lesions with rectal neuroendocrine tumors, n (%)

Variables	Total (n = 128)			Matched set (n = 58)
	ESD (n = 84)	TEM (n = 44)	P value	ESD (n = 29)	TEM (n = 29)	P value
Lesion size, mm, median (IQR)	8.0 (5.5-10.0)	8.0 (5.0-10.0)	0.716	5.0 (5.0-10.0)	5.0 (5.0-10.0)	1.000
Age, year, mean ± SD	44.7 ± 13.5	45.3 ± 12.2	0.491	44.8 ± 14.7	41.9 ± 9.9	0.293
Follow-up time, month, median (IQR)	27.0 (15.0-45.0)	26.5 (16.0-38.0)	0.934	23.0 (12.0-34.0)	24.0 (16.0-32.0)	0.828
Male	45 (60.0)	30 (68.2)	0.221	15 (51.7)	21 (72.4)	0.104
Location
Anus ≤ 5 cm	32 (38.1)	23 (52.3)	0.124	13 (44.8)	14 (48.3)	0.792
Anus > 5 cm	52 (61.9)	21 (47.7)		16 (55.2)	15 (51.7)
Histological grade
G1	75 (89.3)	29 (65.9)	0.001	26 (89.7)	26 (89.7)	1.000
G2	9 (10.7)	15 (34.1)		3 (10.3)	3 (10.3)
Invasion depth
Mucosa	6 (7.1)	2 (4.5)	0.714	2 (6.9)	1 (3.4)	1.000
Submucosa	78 (92.9)	42 (95.5)		27 (93.1)	28 (96.6)
Vascular invasion	1 (1.2)	0 (0.0)	1.000	0 (0.0)	0 (0.0)	/
Perineural invasion	0 (0.0)	1 (2.3)	0.344	0 (0.0)	0 (0.0)	/

ESD: Endoscopic submucosal dissection; TEM: Transanal endoscopic microsurgery; IQR: Interquartile range.

Table 2 Outcomes between endoscopic submucosal dissection and transanal endoscopic microsurgery groups, n (%)

Variables	Total (n = 128)			Matched set (n = 58)
	ESD (n = 84)	TEM (n = 44)	P value	ESD (n = 29)	TEM (n = 29)	P value
Hospital day, day, median (IQR)	6.0 (5.0-7.0)	9.0 (7.0-12.0)	< 0.001	5.5 (4.5-6.0)	10.0 (7.0-12.0)	< 0.001
Cost, kilo-CNY, median (IQR)	11.2 (9.6-12.6)	21.3 (17.4-26.7)	< 0.001	11.6 (9.8-12.6)	20.9 (17.0-25.1)	< 0.001
Anesthesia type
Awake	48 (57.1)	0 (0.0)	< 0.001	17 (58.6)	0 (0.0)	< 0.001
Venous sedation	36 (42.9)	0 (0.0)		12 (41.4)	0 (0.0)
Tracheal intubation	0 (0.0)	44 (100.0)		0 (0.0)	29 (100.0)
Adverse event	3 (3.6)	2 (4.5)	1.000	0 (0.0)	2 (6.9)	0.491
En bloc resection	84 (100.0)	44 (100.0)	/	29 (100.0)	29 (100.0)	/
R0 resection	73 (86.9)	43 (97.7)	0.057	24 (82.8)	28 (96.6)	0.194
Recurrence	0 (0.0)	1 (2.3)	0.348	0 (0.0)	1 (3.4)	1.000

ESD: Endoscopic submucosal dissection; TEM: Transanal endoscopic microsurgery; IQR: Interquartile range; CNY: China Yuan.

Table 3 Outcomes between endoscopic submucosal dissection and transanal endoscopic microsurgery groups according to lesion size, n (%)

Variables	< 10 mm (n = 84)			10-20 mm (n = 44)
	ESD (n = 56)	TEM (n = 28)	P value	ESD (n = 28)	TEM (n = 16)	P value
Lesion size, mm, median (IQR)	6.0 (5.0-8.0)	5.0 (4.5-8.0)	0.101	10.0 (10.0-12.0)	11.0 (10.0-15.0)	0.277
Age, year, mean ± SD	44.8 ± 14.1	44.3 ± 11.9	0.872	44.4 ± 12.4	47.1 ± 12.9	0.513
Follow-up time, month, median (IQR)	24.5 (12.5-36.0)	23.0 (15.0-38.0)	0.962	35.0 (20.0-54.0)	30.0 (22.5-48.0)	0.798
Hospital day, day, median (IQR)	6.0 (5.0-7.0)	9.0 (7.0-11.5)	< 0.001	6.0 (5.0-7.0)	9.0 (7.0-13.0)	< 0.001
Cost, kilo-CNY, median (IQR)	10.8 (9.5-12.2)	22.4 (18.3-26.7)	< 0.001	11.5 (10.2-12.6)	20.0 (16.9-24.8)	< 0.001
Adverse event	1 (1.8)	1 (3.6)	1.000	2 (7.1)	1 (6.3)	1.000
En bloc resection	56 (100.0)	28 (100.0)	/	23 (100.0)	16 (100.0)	/
R0 resection	50 (89.3)	27 (96.4)	0.416	23 (82.1)	16 (100.0)	0.141
Recurrence	0 (0.0)	0 (0.0)	/	0 (0.0)	1 (6.3)	0.364

ESD: Endoscopic submucosal dissection; TEM: Transanal endoscopic microsurgery; IQR: Interquartile range; CNY: China Yuan.

Table 4 The characteristics of 12 lesions with non-R0 resection, n (%)

	Non-R0 resection, n = 12	R0 resection, n = 116	P value
Age, year, mean ± SD	39.6 ± 9.4	45.4 ± 13.2	0.138
Lesion size, mm, median (IQR)	8.0 (5.0-10.0)	8.0 (5.0-10.0)	0.885
Male	8 (66.7)	67 (57.8)	0.764
Location
Anus ≤ 5 cm	5 (41.7)	50 (43.1)	0.924
Anus > 5 cm	7 (58.3)	66 (56.9)
Resection method
ESD	11 (91.7)	73 (62.9)	0.057
TEM	1 (8.3)	43 (37.1)
Grade
G1	12 (100.0)	92 (79.3)	0.121
G2	0 (0.0)	24 (20.7)
Invasion depth
Mucosal	0 (0.0)	8 (6.9)	1.000
Submucosal	12 (100.0)	108 (93.1)
Vascular invasion	0 (0.0)	1 (0.9)	1.000
Perineural invasion	0 (0.0)	1 (0.9)	1.000

ESD: Endoscopic submucosal dissection; TEM: Transanal endoscopic microsurgery; IQR: Interquartile range.