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Risk factors for residual tumors in histologically incompletely resected rectal neuroendocrine tumors.

Jung-Bin Park1, Ga Hee Kim1, Minjun Kim1

  • 1Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
|April 19, 2025
PubMed
Summary

Rectal neuroendocrine tumors (r-NETs) are frequently incompletely resected. Salvage local resection (SLR) is crucial for residual r-NETs, especially when primary resection is incomplete or uses cold forceps polypectomy.

Keywords:
Neuroendocrine tumorRectumSalvage therapy

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The Influence of Liver Resection on Intrahepatic Tumor Growth
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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Gastrointestinal Endoscopy

Background:

  • Rectal neuroendocrine tumors (r-NETs) are often misdiagnosed as polyps, leading to inadequate endoscopic treatment and incomplete tumor removal.
  • Incomplete resection of r-NETs poses a significant challenge, potentially leading to recurrence and necessitating further intervention.

Purpose of the Study:

  • To determine the incidence of residual r-NETs after salvage local resection (SLR) in patients with initially incomplete resection.
  • To identify risk factors associated with residual r-NETs following SLR.

Main Methods:

  • Analysis of medical records for 95 patients who underwent SLR for histologically incompletely resected (R1/Rx) r-NETs.
  • Data collected from January 2020 to August 2023, focusing on primary resection methods and endoscopic findings.

Main Results:

  • The overall rate of residual r-NETs after SLR was 48.4%.
  • Higher residual rates were observed with cold forceps polypectomy (70.0%) and conventional endoscopic mucosal resection (EMR) (41.7%) compared to modified EMR/endoscopic submucosal dissection (0%).
  • Endoscopically suspected remnant tumors before SLR and the use of cold forceps polypectomy for primary resection were significant risk factors for residual r-NETs.

Conclusions:

  • Salvage local resection is a critical consideration for r-NETs with incomplete primary resection (R1/Rx).
  • Identifying and addressing risk factors, such as primary resection method and endoscopic suspicion of residual tumor, can optimize SLR outcomes.
  • Further investigation into optimizing endoscopic techniques for primary r-NET resection is warranted to minimize residual disease.