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Full-Endoscopic Surgery for Hypothalamic Hamartoma Resection
Published on: April 12, 2024
Clinical outcomes of endoscopic mucosal resection for rectal neuroendocrine tumor
Jihye Kim1, Jee Hyun Kim2, Joo Young Lee1
1Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Republic of Korea.
Background:
The incidence of rectal neuroendocrine tumors (NETs) is rapidly increasing because of the frequent use of endoscopic screening for colorectal cancers. However, the clinical outcomes of endoscopic resection for rectal NETs are still unclear. The aim of this study was to assess the rates of histologically complete resection (H-CR) and recurrence after endoscopic mucosal resection (EMR) for rectal NETs.
Methods:
A retrospective analysis was performed on patients who underwent EMR for rectal NETs between January 2002 and March 2015 at Seoul National University Hospital. Primary outcomes were H-CR and recurrence rates after endoscopic resection. H-CR was defined as the absence of tumor invasion in the lateral and deep margins of resected specimens.
Results:
Among 277 patients, 243 (88%) were treated with conventional EMR, 23 (8%) with EMR using a dual-channel endoscope, and 11 (4%) with EMR after precutting. The median tumor size was 4.96 mm (range, 1-22) in diameter, and 264 (95%) lesions were confined to the mucosa and submucosal layer. The en-bloc resection rate was 99% and all patients achieved endoscopically complete resection. The H-CR rates were 75, 74, and 73% for conventional EMR, EMR using a dual-channel endoscope, and EMR after precutting, respectively. Multivariate analysis showed that H-CR was associated with tumor size regardless of endoscopic treatment modalities (p = 0.023). Of the 277 patients, 183 (66%) underwent at least 1 endoscopic follow-up. Three (2%) of these 183 patients had tumor recurrence, which was diagnosed at a median of 62.5 months (range 19-98) after endoscopic resection. There was 1 case of disease-related death, which occurred 167 months after endoscopic treatment because of bone marrow failure that resulted from tumor metastasis.
Conclusions:
Although the en-bloc resection rate was 99% in rectal NETs, H-CR rates were 72-74% for various EMR procedures. H-CR may be associated with tumor size regardless of endoscopic treatment modalities.
Insights
Endoscopic mucosal resection (EMR) for rectal neuroendocrine tumors (NETs) achieves high en-bloc resection rates but variable histologically complete resection (H-CR) rates, influenced by tumor size. Recurrence is low, but long-term follow-up is crucial.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Endoscopic Procedures
Background:
- Rectal neuroendocrine tumors (NETs) incidence is rising due to increased endoscopic screening.
- Clinical outcomes and completeness of resection for rectal NETs via endoscopic mucosal resection (EMR) require further clarification.
Purpose of the Study:
- To evaluate the rates of histologically complete resection (H-CR) and recurrence following EMR for rectal NETs.
- To identify factors associated with successful H-CR in rectal NETs treated endoscopically.
Main Methods:
- Retrospective analysis of 277 patients undergoing EMR for rectal NETs (2002-2015).
- Primary outcomes: H-CR (defined by margin status) and recurrence rates.
- Multivariate analysis to assess predictors of H-CR.
Main Results:
- High en-bloc resection rate (99%) achieved across different EMR techniques.
- H-CR rates ranged from 72-75% depending on EMR method.
- Tumor size was significantly associated with H-CR (p=0.023).
- Low recurrence rate (2%) observed in patients with follow-up; one disease-related death occurred due to metastasis.
Conclusions:
- EMR provides high en-bloc resection for rectal NETs, but achieving H-CR is variable.
- Tumor size is a key factor influencing H-CR, irrespective of EMR technique.
- While recurrence is infrequent, long-term surveillance is warranted given the potential for metastasis.
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