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

IntroductionCurrently, complete tumor resection is considered the most effective treatment for rectal neuroendocrine tumors (NETs). Endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) are recommended for rectalNETs ≤2 cm, but it is not clear which method is better. Thus, we evaluated the efficacy of ESD and TEM in the treatment of rectal neuroendocrine tumors (NETs) ≤ 2 cm.MethodsWe conducted a single-centre retrospective cohort study between 2010 and 2021 of rectal NETs ≤ 2 cm in 114 patients with long-term follow-up data who were divided into ESD (n=55) and TEM groups (n=59). Our study assessed differences between groups in the complete resection rate of lesions, recurrence rate, surgical complications, procedure time, and length of hospital stay.ResultsThe co-primary outcomes were the complete resection rate of lesions and the recurrence rate. Compared to that in the ESD group, the complete resection rate was significantly higher in the TEM group (91.5% vs. 70.9%, p=0.005). The median follow-up time was 22 months in our study, and the follow-up outcomes suggested that the rates of recurrence were 1.8% (1/55) and 6.8% (4/59) in the ESD and TEM groups, respectively, with no significant difference between the two groups. The secondary outcomes of the evaluation were surgical complications, procedural time, and length of hospital stay. The rate of complications (gastrointestinal bleeding and perforation) was low in both the ESD (7.3%, 4/55) and TEM (5.1%, 3/59) groups. No difference in hospitalization duration was observed between the two groups in our study. However, the procedure time was significantly shorter in the ESD group than in the TEM group (27.5 min vs. 56 min, p<0.001).ConclusionsAlthough the rate of complete resection in the TEM group was higher than that in the ESD group, there was no difference in recurrence rates between the two modalities during long-term follow-up. Depending on the qualities of the available hospital resources in the area, one of the two approaches can be adopted.

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“…Similarly, Pattarajierapan et al. also found that 2.2% of rectal NET patients with positive margins had no recurrence ( 18 ). Li et al.…”

Section: Discussionmentioning

confidence: 94%

Comparison of the efficacy of endoscopic submucosal dissection and transanal endoscopic microsurgery in the treatment of rectal neuroendocrine tumors ≤ 2 cm

Jin

Bai

et al. 2023

Front. Endocrinol.

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Current status of the role of endoscopy in evaluation and management of gastrointestinal and pancreatic neuroendocrine tumors

Nabi

Lakhtakia

Reddy

2023

Indian J Gastroenterol

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Efficacy of endoscopic mucosal resection versus endoscopic submucosal dissection for rectal neuroendocrine tumors ≤10mm: a systematic review and meta-analysis

Zhou

Zhang

2023

Ann Saudi Med

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BACKGROUND: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are surgical methods used for rectal neuroendocrine tumors (NETs) with diameters of ≤ 10 mm. However, which method has a higher performance remains uncertain. OBJECTIVES: Evaluate which of the two methods shows a higher performance. DESIGN: Systematic review and meta-analysis METHODS: Data from PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to 12 April 2022. Outcomes, including complete resection, en bloc resection, recurrence, perforation, bleeding, and procedure time, were pooled by 95% confidence intervals (95% CI) using a fixed- or random-effects model. MAIN OUTCOME MEASURES: Complete resection, en bloc resection, and recurrence. SAMPLE SIZE: 18 studies, including 1168 patients were included in the study. RESULTS: Eighteen retrospective cohort studies were included in this meta-analysis. There were no statistical differences in the rates of complete resection, en bloc resection, recurrence, perforation, and bleeding rates between EMR and ESD. However, a statistical difference was detected in the procedure time; EMR had a significantly shorter time (MD=−17.47, 95% CI=−22.31 – −12.62, P <.00001). CONCLUSIONS: EMR and ESD had similar efficacies and safety profiles in resectioning rectal NETs ≤ 10 mm. Even so, the advantages of EMR included a shorter operation time and expenditure. Thus, with respect to health economics, EMR outperformed ESD. LIMITATION: Most of these studies are retrospective cohort studies instead of RCTs. CONFLICT OF INTEREST: None.

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

Cited by 3 publications

References 26 publications

Comparison of the efficacy of endoscopic submucosal dissection and transanal endoscopic microsurgery in the treatment of rectal neuroendocrine tumors ≤ 2 cm

Comparison of the efficacy of endoscopic submucosal dissection and transanal endoscopic microsurgery in the treatment of rectal neuroendocrine tumors ≤ 2 cm

Current status of the role of endoscopy in evaluation and management of gastrointestinal and pancreatic neuroendocrine tumors

Efficacy of endoscopic mucosal resection versus endoscopic submucosal dissection for rectal neuroendocrine tumors ≤10mm: a systematic review and meta-analysis

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