Efficacy of Endoscopic Resection for Rectal Neuroendocrine Tumors Smaller than 15 mm.
Carcinoid tumor
Endoscopic mucosal resection
Neoplasm metastasis
Neuroendocrine tumors
Rectal neoplasms
Transanal endoscopic surgery
Journal
Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782
Informations de publication
Date de publication:
07 2023
07 2023
Historique:
received:
29
09
2022
accepted:
02
03
2023
medline:
28
6
2023
pubmed:
7
4
2023
entrez:
6
4
2023
Statut:
ppublish
Résumé
Local resection, including endoscopic resection, is recommended for rectal neuroendocrine tumors (NETs) < 15 mm in patients without risk factors for metastasis, though the short- and long-term outcomes are unclear. This study investigates the efficacy of endoscopic resection for rectal NETs < 15 mm. The short- and long-term outcomes of patients with rectal NETs < 15 mm who underwent endoscopic resection and the outcomes of each endoscopic technique were analyzed. The tumors were stratified as < 10 mm (small-size group, SSG) and 10-14 mm (intermediate-size group, IMG). Overall, 139 lesions (SSG, n = 118; IMG, n = 21) were analyzed. All tumors were classified as G1 (n = 135) or G2 (n = 4) according to the 2019 World Health Organization grading criteria. The complete resection rate was not different between the groups (P = 0.151). Endoscopic submucosal dissection (ESD) and endoscopic submucosal resection with a ligation device (ESMR-L) achieved complete resection rates > 90% in the SSG. The ESMR-L procedure time (P < 0.001) and hospitalized period (P < 0.001) were significantly shorter than those of ESD. ESD achieved a complete resection rate of 80.0% in the IMG. The tumor size did not affect the overall survival or rate of lymph node/distant metastases. Endoscopic resection is a feasible and effective treatment for patients with rectal NETs < 15 mm without the risk factors of metastasis. ESMR-L and ESD are optimal techniques for resecting tumors smaller than 10 mm and 10-14 mm, respectively.
Sections du résumé
BACKGROUND
Local resection, including endoscopic resection, is recommended for rectal neuroendocrine tumors (NETs) < 15 mm in patients without risk factors for metastasis, though the short- and long-term outcomes are unclear.
AIMS
This study investigates the efficacy of endoscopic resection for rectal NETs < 15 mm.
METHODS
The short- and long-term outcomes of patients with rectal NETs < 15 mm who underwent endoscopic resection and the outcomes of each endoscopic technique were analyzed. The tumors were stratified as < 10 mm (small-size group, SSG) and 10-14 mm (intermediate-size group, IMG).
RESULTS
Overall, 139 lesions (SSG, n = 118; IMG, n = 21) were analyzed. All tumors were classified as G1 (n = 135) or G2 (n = 4) according to the 2019 World Health Organization grading criteria. The complete resection rate was not different between the groups (P = 0.151). Endoscopic submucosal dissection (ESD) and endoscopic submucosal resection with a ligation device (ESMR-L) achieved complete resection rates > 90% in the SSG. The ESMR-L procedure time (P < 0.001) and hospitalized period (P < 0.001) were significantly shorter than those of ESD. ESD achieved a complete resection rate of 80.0% in the IMG. The tumor size did not affect the overall survival or rate of lymph node/distant metastases.
CONCLUSIONS
Endoscopic resection is a feasible and effective treatment for patients with rectal NETs < 15 mm without the risk factors of metastasis. ESMR-L and ESD are optimal techniques for resecting tumors smaller than 10 mm and 10-14 mm, respectively.
Identifiants
pubmed: 37024740
doi: 10.1007/s10620-023-07914-4
pii: 10.1007/s10620-023-07914-4
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3148-3157Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Gallo C, Rossi RE, Cavalcoli F et al. Rectal neuroendocrine tumors: current advances in management, treatment, and surveillance. World J Gastroenterol. 2022;28:1123–1138.
doi: 10.3748/wjg.v28.i11.1123
Osagiede O, Habermann E, Day C et al. Factors associated with worse outcomes for colorectal neuroendocrine tumors in radical versus local resections. J Gastrointest Oncol. 2020;11:836–846.
doi: 10.21037/jgo-20-193
Wang XY, Chai NL, Linghu EQ et al. Efficacy and safety of hybrid endoscopic submucosal dissection compared with endoscopic submucosal dissection for rectal neuroendocrine tumors and risk factors associated with incomplete endoscopic resection. Ann Transl Med. 2020;8:368.
doi: 10.21037/atm.2020.02.25
Ploeckinger U, Kloeppel G, Wiedenmann B et al. The German NET-registry: an audit on the diagnosis and therapy of neuroendocrine tumors. Neuroendocrinology. 2009;90:349–363.
doi: 10.1159/000242109
Dasari A, Shen C, Halperin D et al. Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol. 2017;3:1335–1342.
doi: 10.1001/jamaoncol.2017.0589
Chang JS, Chen LT, Shan YS et al. An updated analysis of the epidemiologic trends of neuroendocrine tumors in Taiwan. Sci Rep. 2021;11:7881.
doi: 10.1038/s41598-021-86839-2
Scherübl H, Cadiot G. Early gastroenteropancreatic neuroendocrine tumors: endoscopic therapy and surveillance. Visc Med. 2017;33:332–338.
doi: 10.1159/000459404
Basuroy R, O’Donnell CM, Srirajaskanthan R et al. Ileocolonic neuroendocrine tumours identified in the English bowel cancer screening programme. Colorectal Dis. 2018;20:O85–O91.
doi: 10.1111/codi.14033
Dąbkowski K, Szczepkowski M, Kos-Kudła B et al. Endoscopic management of rectal neuroendocrine tumours. How to avoid a mistake and what to do when one is made? Endokrynol Pol 2020;71:343–349.
doi: 10.5603/EP.a2020.0045
Chen HT, Xu GQ, Teng XD et al. Diagnostic accuracy of endoscopic ultrasonography for rectal neuroendocrine neoplasms. World J Gastroenterol. 2014;20:10470–10477.
doi: 10.3748/wjg.v20.i30.10470
Ngamruengphong S, Kamal A, Akshintala V et al. Prevalence of metastasis and survival of 788 patients with T1 rectal carcinoid tumors. Gastrointest Endosc. 2019;89:602–606.
doi: 10.1016/j.gie.2018.11.010
Kuiper T, van Oijen MGH, van Velthuysen MF et al. Endoscopically removed rectal NETs: a nationwide cohort study. Int J Colorectal Dis. 2021;36:535–541.
doi: 10.1007/s00384-020-03801-w
Matsuhashi N, Takahashi T, Tomita H et al. Evaluation of treatment for rectal neuroendocrine tumors sized under 20 mm in comparison with the WHO 2010 guidelines. Mol Clin Oncol. 2017;7:476–480.
doi: 10.3892/mco.2017.1326
Ito T, Masui T, Komoto I et al. JNETS clinical practice guidelines for gastroenteropancreatic neuroendocrine neoplasms: diagnosis, treatment, and follow-up: a synopsis. J Gastroenterol. 2021;56:1033–1044.
doi: 10.1007/s00535-021-01827-7
Kunz PL, Reidy-Lagunes D, Anthony LB et al. Consensus guidelines for the management and treatment of neuroendocrine tumors. Pancreas. 2013;42:557–577.
doi: 10.1097/MPA.0b013e31828e34a4
Ramage JK, De Herder WW, Delle Fave G et al. ENETS consensus guidelines update for colorectal neuroendocrine neoplasms. Neuroendocrinology. 2016;103:139–143.
doi: 10.1159/000443166
Kulke MH, Shah MH, Benson AB 3rd et al. Neuroendocrine tumors, version 1.2015. J Natl Compr Canc Netw. 2015;13:78–108.
doi: 10.6004/jnccn.2015.0011
Park CH, Cheon JH, Kim JO et al. Criteria for decision making after endoscopic resection of well-differentiated rectal carcinoids with regard to potential lymphatic spread. Endoscopy. 2011;43:790–795.
doi: 10.1055/s-0030-1256414
de Mestier L, Brixi H, Gincul R et al. Updating the management of patients with rectal neuroendocrine tumors. Endoscopy. 2013;45:1039–1046.
doi: 10.1055/s-0033-1344794
Chida K, Watanabe J, Hirasawa K et al. A novel risk-scoring system for predicting lymph node metastasis of rectal neuroendocrine tumors. Ann Gastroenterol Surg. 2020;4:562–570.
doi: 10.1002/ags3.12355
Zheng X, Wu M, Er L et al. Risk factors for lymph node metastasis and prognosis in colorectal neuroendocrine tumours. Int J Colorectal Dis. 2022;37:421–428.
doi: 10.1007/s00384-021-04082-7
Rossi RE, Elvevi A, Gallo C et al. Endoscopic techniques for diagnosis and treatment of gastro-entero-pancreatic neuroendocrine neoplasms: Where we are. World J Gastroenterol. 2022;28:3258–3273.
doi: 10.3748/wjg.v28.i26.3258
Hamada Y, Tanaka K, Tano S et al. Usefulness of endoscopic submucosal dissection for the treatment of rectal carcinoid tumors. Eur J Gastroenterol Hepatol. 2012;24:770–774.
doi: 10.1097/MEG.0b013e3283526f38
Chen T, Yao LQ, Xu MD et al. Efficacy and safety of endoscopic submucosal dissection for colorectal carcinoids. Clin Gastroenterol Hepatol. 2016;14:575–581.
doi: 10.1016/j.cgh.2015.07.048
Lim HK, Lee SJ, Baek DH et al. Resectability of rectal neuroendocrine tumors using endoscopic mucosal resection with a ligation band device and endoscopic submucosal dissection. Gastroenterol Res Pract. 2019;2019:8425157.
doi: 10.1155/2019/8425157
Takita M, Sakai E, Nakao T et al. Clinical outcomes of patients with small rectal neuroendocrine tumors treated using endoscopic submucosal resection with a ligation device. Digestion 2019;99:72–78.
doi: 10.1159/000494416
Park SB, Kim HW, Kang DH et al. Advantage of endoscopic mucosal resection with a cap for rectal neuroendocrine tumors. World J Gastroenterol. 2015;21:9387–9393.
doi: 10.3748/wjg.v21.i31.9387
Nagai T, Torishima R, Nakashima H et al. Saline-assisted endoscopic resection of rectal carcinoids: cap aspiration method versus simple snare resection. Endoscopy. 2004;36:202–205.
doi: 10.1055/s-2004-814248
Chen R, Liu X, Sun S et al. Comparison of endoscopic mucosal resection with circumferential incision and endoscopic submucosal dissection for rectal carcinoid tumor. Surg Laparosc Endosc Percutan Tech. 2016;26:e56-61.
doi: 10.1097/SLE.0000000000000266
Zhang J, Liu M, Li H et al. Comparison of endoscopic therapies for rectal carcinoid tumors: Endoscopic mucosal resection with circumferential incision versus endoscopic submucosal dissection. Clin Res Hepatol Gastroenterol. 2018;42:24–30.
doi: 10.1016/j.clinre.2017.06.007
Meier B, Albrecht H, Wiedbrauck T et al. Full-thickness resection of neuroendocrine tumors in the rectum. Endoscopy. 2020;52:68–72.
doi: 10.1055/a-1008-9077
Zhou X, Xie H, Xie L et al. Endoscopic resection therapies for rectal neuroendocrine tumors: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2014;29:259–268.
doi: 10.1111/jgh.12395
Hamada Y, Tanaka K, Hattori A et al. Clinical utility of endoscopic submucosal dissection using the pocket-creation method with a HookKnife and preoperative evaluation by endoscopic ultrasonography for the treatment of rectal neuroendocrine tumors. Surg Endosc. 2022;36:375–384.
doi: 10.1007/s00464-021-08292-6
Mashimo Y, Matsuda T, Uraoka T et al. Endoscopic submucosal resection with a ligation device is an effective and safe treatment for carcinoid tumors in the lower rectum. J Gastroenterol Hepatol. 2008;23:218–221.
doi: 10.1111/j.1440-1746.2008.05313.x
Kim HH, Park SJ, Lee SH et al. Efficacy of endoscopic submucosal resection with a ligation device for removing small rectal carcinoid tumor compared with endoscopic mucosal resection: analysis of 100 cases. Dig Endosc. 2012;24:159–163.
doi: 10.1111/j.1443-1661.2011.01190.x
Park SS, Kim BC, Lee DE et al. 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.e402.
doi: 10.1016/j.gie.2021.02.012
Brand M, Reimer S, Reibetanz J et al. Endoscopic full thickness resection vs. transanal endoscopic microsurgery for local treatment of rectal neuroendocrine tumors—a retrospective analysis. Int J Colorectal Dis. 2021;36:971–976.
doi: 10.1007/s00384-020-03800-x