Optimal endoscopic resection method based on vertical margin distance for small rectal neuroendocrine tumors:...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Endoscopic Procedures

Background:

• Rectal neuroendocrine tumors (NETs) less than 10 mm often require advanced endoscopic resection.
• Optimal endoscopic technique for these tumors remains debated.
• Efficacy and safety of endoscopic mucosal resection with ligation (EMR-L) versus endoscopic submucosal dissection (ESD) need clarification.

Purpose of the Study:

• To compare the efficacy and safety of EMR-L and ESD for rectal NETs ≤ 10 mm.
• To determine if EMR-L achieves superior outcomes, particularly adequate vertical margin distance.
• To evaluate procedure time and complication rates between the two techniques.

Main Methods:

• A dual-center cohort study included patients with rectal NETs ≤ 10 mm.
• Propensity score matching (PSM) was used to create comparable groups for EMR-L and ESD.
• Adequate vertical margins were defined as > 115 μm.

Main Results:

• After PSM, 61 lesions were analyzed in each group (EMR-L vs. ESD).
• EMR-L showed significantly higher R0 resection rates (98.4% vs. 83.6%) and adequate vertical margins (80.3% vs. 62.3%).
• EMR-L procedures were shorter (median 5.0 vs. 19 min) with fewer complications (8.2% vs. 29.5%), especially perforations (3.3% vs. 16.4%).

Conclusions:

• EMR-L is superior to ESD for small rectal NETs, achieving better R0 resection and vertical margins.
• EMR-L offers significant advantages in reduced procedure time and lower complication rates.
• EMR-L represents a safer and more efficient endoscopic approach for selected rectal NETs.