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Local Excision Versus Radical Resection for Grade 2 Rectal Neuroendocrine Tumors: A Multicenter Propensity

Xinyu Zeng1, Rui Zhang2, Weizhong Jiang3

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|March 7, 2024
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For grade 2 rectal neuroendocrine tumors, local excision is suitable for tumors ≤1.5 cm without metastasis. Radical resection is more beneficial for tumors >1.5 cm due to a non-negligible lymph node metastasis rate.

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Oncology

Background:

  • Limited studies exist on grade 2 rectal neuroendocrine tumors (NETs).
  • Optimal treatment strategies for these tumors remain undefined.
  • Rectal NETs require careful consideration due to potential for metastasis.

Purpose of the Study:

  • To compare oncologic outcomes of local excision versus radical resection for grade 2 rectal NETs.
  • To evaluate the efficacy of different surgical approaches in relation to tumor size and lymph node status.
  • To provide evidence-based recommendations for surgical management of rectal NETs.

Main Methods:

  • Retrospective, multicenter, propensity score-matched study.
  • 144 patients with pathologically confirmed grade 2 rectal NETs were analyzed.
  • Outcomes assessed included cancer-specific survival and relapse-free survival.

Main Results:

  • Tumor size ≤1.5 cm: No significant difference in survival between local excision and radical resection (p > 0.05).
  • Tumor size >1.5 cm: Significantly lower relapse-free survival in the local excision group compared to radical resection (p = 0.04).
  • 60% of patients undergoing radical resection had positive lymph nodes, indicating a significant metastasis rate.

Conclusions:

  • Local excision is a feasible option for grade 2 rectal NETs ≤1.5 cm without metastasis.
  • Radical resection is recommended for tumors >1.5 cm due to higher risk of recurrence.
  • Grade 2 rectal NETs have a considerable rate of lymph node metastasis, necessitating tailored surgical strategies.