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Published on: February 12, 2022
Management of rectal neuroendocrine tumours by transanal endoscopic microsurgery
Jessica J Lie1,2, Hyea Min Yoon3, Ahmer A Karimuddin1,3
1Department of Surgery, University of British Columbia, British Columbia, Vancouver, Canada.
Aim:
The objective of this study was to evaluate the safety and effectiveness of transanal endoscopic microsurgery for rectal neuroendocrine tumours.
Method:
A retrospective cohort study of all pathology-confirmed rectal neuroendocrine tumours treated by transanal endoscopic microsurgery from April 2007 to December 2020 at a tertiary care centre was performed. Demographic, clinical, radiographic and pathological data were collected. Characteristics of patients with recurrence were examined. Descriptive statistics were performed.
Results:
There were 58 patients treated by transanal endoscopic microsurgery excision. Referrals were for primary excision (15, 25.9%), completion re-excision after incomplete endoscopic removal (38, 65.5%) or locally recurrent rectal neuroendocrine tumours (5, 8.6%). The mean age of patients was 56.4 ± 11.9 years and 26 patients were women (44.8%). Mean tumour size was 7.4 ± 3.8 mm (range 1.0-15.0 mm). Most (86.4%) were Grade 1 tumours. Mean operative time was 37.2 ± 17.2 min and 56 patients (96.6%) were discharged on the same day. All patients had negative margins on final pathology. Of the 38 patients who were referred for completion re-excision after incomplete endoscopic removal, eight (21.1%) had residual tumour on final pathology. Three recurrences were diagnosed at 2.1, 4.5 and 12.5 years after excision. All recurrences were from Grade 1 or 2 primary tumours, less than 2 cm, and diagnosed radiographically.
Conclusion:
To date, this is the largest North American study looking at transanal endoscopic microsurgery for rectal neuroendocrine tumours. This technique is effective in managing primary, incompletely excised and recurrent tumours with good clinical and oncological outcomes.
Insights
Transanal endoscopic microsurgery is effective for rectal neuroendocrine tumours, offering good outcomes for primary, incomplete, and recurrent cases. This technique demonstrates safety and efficacy in managing these rare gastrointestinal tumours.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Colorectal Surgery
Background:
- Rectal neuroendocrine tumours (NETs) are rare neoplasms requiring effective treatment strategies.
- Transanal endoscopic microsurgery (TEM) is a minimally invasive approach for rectal lesions.
Purpose of the Study:
- To evaluate the safety and effectiveness of transanal endoscopic microsurgery (TEM) for rectal neuroendocrine tumours (NETs).
Main Methods:
- Retrospective cohort study of 58 patients with rectal NETs treated with TEM between April 2007 and December 2020.
- Data collected included demographics, clinical, radiographic, and pathological characteristics, with a focus on recurrence patterns.
Main Results:
- TEM was used for primary excision (25.9%), completion re-excision (65.5%), and recurrent NETs (8.6%).
- Mean operative time was 37.2 minutes, with 96.6% same-day discharge.
- All patients achieved negative margins, though 21.1% of re-excisions had residual tumour. Three recurrences were observed, all from low-grade, small tumours.
Conclusions:
- Transanal endoscopic microsurgery is an effective technique for managing rectal neuroendocrine tumours.
- TEM offers good clinical and oncological outcomes for primary, incompletely excised, and recurrent rectal NETs.
