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Long-term clinical outcomes of endoscopic submucosal dissection in rectal neuroendocrine tumors based on resection
Di Sun1,2,3,4, Zhong Ren1,2, Enpan Xu1,2
1Endoscopy Center, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
Background:
Endoscopic submucosal dissection (ESD) has been widely adopted in treating rectal neuroendocrine tumors (NETs). However, clinical outcomes in rectal NETs after ESD with different resection margin status remain scanty, particularly in patients with positive resection margins. This study aimed to evaluate the long-term clinical outcomes of ESD in rectal NET based on the resection margin status.
Methods:
This retrospective study included 436 patients diagnosed with rectal NET who had undergone ESD. Clinical data, including age, sex, tumor size, stage, invasion, and the resection margin status, were collected. Further, the patients were assessed for complications, recurrence, distant metastasis, and long-term outcomes.
Results:
Among all 436 patients, 395 patients had their primary ESD in our hospital. Complete resection was achieved in 319 patients. Patients who did not achieve complete resection opted for follow-up (n = 73), salvage surgery (n = 1) and salvage ESD (n = 2). Another 41 had their primary ESD in other hospital with incomplete resection and had salvage ESD in our hospital. All 436 patients had a median follow-up period of 61.4 months (range 33.4-125.3 months). During the follow-up period, two patients developed recurrences, while three patients developed metastasis. There were no significant differences in the 5-year progression-free survival and overall survival between patients with incomplete resection opting for follow-up compared to the other two groups (P = 0.5/0.8). However, the complication rates were significantly higher in patients who received salvage ESD.
Conclusion:
This study demonstrated that positive resection margins have no influence on survival in patients with rectal NET treated using ESD.
Insights
Endoscopic submucosal dissection (ESD) for rectal neuroendocrine tumors (NETs) shows positive resection margins do not impact patient survival. Long-term outcomes were evaluated, finding no significant difference in survival rates based on margin status.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Endoscopic Procedures
Background:
- Endoscopic submucosal dissection (ESD) is a common treatment for rectal neuroendocrine tumors (NETs).
- Limited data exists on long-term outcomes for rectal NETs after ESD, especially concerning positive resection margins.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of rectal NETs treated with ESD, focusing on the impact of resection margin status.
Main Methods:
- A retrospective study of 436 patients with rectal NET who underwent ESD.
- Data collected included patient demographics, tumor characteristics, and resection margin status.
- Patients were followed for complications, recurrence, metastasis, and long-term survival.
Main Results:
- Complete resection was achieved in 319 patients; 73 opted for follow-up after incomplete resection.
- Over a median follow-up of 61.4 months, two recurrences and three metastases occurred.
- No significant difference in 5-year progression-free or overall survival was observed between incomplete resection groups.
Conclusions:
- Positive resection margins after ESD for rectal NET do not appear to influence patient survival.
- Salvage ESD was associated with higher complication rates compared to follow-up after incomplete resection.
