Local excision versus radical resection in patients with rectal neuroendocrine tumours: a propensity score match analysis

Abstract

Background: The rectum is a common site for neuroendocrine tumours of the gastrointestinal tract. Diagnosis of these tumours has been increasing in recent years, highlighting the need to better define treatment options for patients with rectal neuroendocrine tumours (rNETs). Methods: We performed a retrospective analysis using the National Cancer Database (2004-2014) to compare overall survival (OS) between local excision (LE) and radical resection (RR). To minimize bias, we performed three propensity score-matched comparisons stratified by tumour size: <10 mm, 10-20 mm, >20 mm. We compared OS by Kaplan-Meier analysis. We also examined margin status and postoperative outcomes for each comparison. Results: A total of 12 996 patients underwent surgical treatment for rNET. There was no significant difference in probability of 10-year OS between LE and RR for patients with tumours <10 mm (88.6% versus 83.8%, P = 0.631, respectively) and tumours 10-20 mm (69.5% versus 69.3%, P = 0.226, respectively). In patients with tumours >20 mm, probability of 10-year OS was significantly longer in the LE group (76.5% versus 37.0%, P < 0.001). For all tumour sizes <10 mm and >20 mm, RR had significantly higher rates of 30-day readmission and negative margins. In subset analysis, there was no difference in OS for patients with positive margins after LE versus negative margins after RR for all tumour size groups. Conclusions: Our findings suggest that LE is a reasonable treatment option in patients with rNETs, especially for patients with high perioperative risk. Limitations to this study include its retrospective nature and inability to analyse surgeon decision-making.

Long-term outcomes of 1–2 cm rectal neuroendocrine tumors after local excision or radical resection: A population-based multicenter study

“…For intermediate-sized tumors between 1 and 2 cm, an additional evaluation that assesses the lymph node status and depth of invasion is recommended to guide LE or RR, and the optimal surgical therapy is not well established. Currently, only a few studies have evaluated the outcomes of local versus radical surgical resection of R-NETs 1–2 cm in size [ [6] , [7] , [8] , [9] , [10] ]. Two studies from the National Cancer Database, one of which used propensity score matching (PSM), compared the prognosis of these two groups of R-NETs patients and found no significant differences in overall survival (OS) [ 9 , 10 ].…”

“…Currently, only a few studies have evaluated the outcomes of local versus radical surgical resection of R-NETs 1–2 cm in size [ [6] , [7] , [8] , [9] , [10] ]. Two studies from the National Cancer Database, one of which used propensity score matching (PSM), compared the prognosis of these two groups of R-NETs patients and found no significant differences in overall survival (OS) [ 9 , 10 ]. Therefore, LE has been suggested as a feasible and less morbid option for intermediate-sized R-NETs.…”