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

Wang, Xiangyao; Chai, Ningli; Linghu, Enqiang; Li, Huikai; Zhai, Yaqi; Feng, Xiuxue; Zhang, Wengang; Zou, Jianfeng; Li, Longsong; Xiang, Jia

doi:10.21037/atm.2020.02.25

Cited by 21 publications

(21 citation statements)

References 25 publications

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“…Wang et al [ 1 ] proposed a hybrid ESD as a safe and effective treatment for rectal NETs as an alternative to conventional ESD. Hybrid ESD is a simplified technique where, after the circumferential incision around the lesion, the submucosal injection of a saline solution, and a partial dissection of the submucosa, snaring is performed using a polypectomy snare to dissect the lesion completely, instead of an endoknife.…”

Section: Management Of Rectal Netsmentioning

confidence: 99%

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Diagnosis and Management of Rectal Neuroendocrine Tumors (NETs)

et al. 2021

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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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Section: Management Of Rectal Netsmentioning

confidence: 99%

“…Rectal neuroendocrine tumors (NETs), formerly known as “carcinoid tumors” because of their peculiar characteristics, are rare, with an incidence of 0.17% during screening colonoscopy [ 1 ], but they represent 12–27% of all NETs and 20% of gastrointestinal NETs [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Management of Rectal Neuroendocrine Tumors (NETs)

et al. 2021

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“…It suggests that lesions ≥ 8 mm may involve the submucosal depth, which require us to remove the lesions close to the muscular layer, or even remove part of the muscular layer. In previous studies, R-NETs could not be resected radically, and its influencing factors might include tumor size [ 23 , 24 ], central depression [ 25 ], lesion morphology [ 26 ], pathological level [ 8 ], distance from anus [ 5 ], treatment methods [ 15 ], etc. However, incomplete resection does not necessarily indicate residual or recurrent tumors [ 6 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison between endoscopic mucosal resection with a cap and endoscopic submucosal dissection for rectal neuroendocrine tumors

Zheng

Shi

et al. 2022

BMC Surg

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Background The aim of this study is to evaluate and compare the safety and efficacy of endoscopic mucosal resection with a cap (EMR-c) with those of endoscopic submucosal dissection (ESD) for rectal neuroendocrine tumors (R-NETs) ≤ 15 mm in diameter, and to analyze the risk factors of incomplete resection. Methods A total of 122 patients who underwent EMR-c or ESD for R-NETs at the Fourth Hospital of Hebei Medical University between February 2007 and December 2020 were invovled in this study. The clinical outcomes of two groups were compared and evaluated. Results A total of 122 patients with 128 R-NETs underwent endoscopic resection (EMR-c, 80; ESD, 48). In terms of duration of operation, EMR-c was significantly shorter than ESD (p < 0.001). Univariate analysis and multivariate analysis suggested that tumor diameter ≥ 8 mm was an independent risk factor for incomplete resection in patients with R-NETs in this study. Conclusions Both EMR-c and ESD were safe and effective treatments for R-NETs ≤ 15 mm in diameter. In addition, tumor diameter ≥ 8 mm was an independent risk factor for incomplete resection.

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“…Among the available techniques, EMR is simple and quick, but it has the lowest pathological complete resection rate (28.6%–82.1%) [ 8 - 11 ]. P-EMR is a modification of EMR and has a better pathological complete resection rate (81.2%–96.7%) [ 9 , 12 , 13 , 26 , 27 ]. Although ESD has a pathological complete resection rate of 77.8% to 100%, it is technically difficult and has a higher rate of complications [ 8 , 10 , 12 , 21 , 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…P-EMR is a modification of EMR and has a better pathological complete resection rate (81.2%–96.7%) [ 9 , 12 , 13 , 26 , 27 ]. Although ESD has a pathological complete resection rate of 77.8% to 100%, it is technically difficult and has a higher rate of complications [ 8 , 10 , 12 , 21 , 26 , 27 ]. In our study, we selected the endoscopic treatment modality based on the tumor size and endoscopic morphology due to the unavailability of endoscopic ultrasound.…”

Section: Discussionmentioning

confidence: 99%

Recurrence after endoscopic resection of small rectal neuroendocrine tumors: a retrospective cohort study

Pattarajierapan

Khomvilai

2022

Ann Coloproctol

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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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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

Cited by 21 publications

References 25 publications

Diagnosis and Management of Rectal Neuroendocrine Tumors (NETs)

Diagnosis and Management of Rectal Neuroendocrine Tumors (NETs)

Comparison between endoscopic mucosal resection with a cap and endoscopic submucosal dissection for rectal neuroendocrine tumors

Recurrence after endoscopic resection of small rectal neuroendocrine tumors: a retrospective cohort study

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