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Efficacy of Endoscopic Resection for Rectal Neuroendocrine Tumors Smaller than 15 mm

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An Invited Commentary to this article was published on 22 May 2023

Abstract

Background

Local resection, including endoscopic resection, is recommended for rectal neuroendocrine tumors (NETs) < 15 mm in patients without risk factors for metastasis, though the short- and long-term outcomes are unclear.

Aims

This study investigates the efficacy of endoscopic resection for rectal NETs < 15 mm.

Methods

The short- and long-term outcomes of patients with rectal NETs < 15 mm who underwent endoscopic resection and the outcomes of each endoscopic technique were analyzed. The tumors were stratified as < 10 mm (small-size group, SSG) and 10–14 mm (intermediate-size group, IMG).

Results

Overall, 139 lesions (SSG, n = 118; IMG, n = 21) were analyzed. All tumors were classified as G1 (n = 135) or G2 (n = 4) according to the 2019 World Health Organization grading criteria. The complete resection rate was not different between the groups (P = 0.151). Endoscopic submucosal dissection (ESD) and endoscopic submucosal resection with a ligation device (ESMR-L) achieved complete resection rates > 90% in the SSG. The ESMR-L procedure time (P < 0.001) and hospitalized period (P < 0.001) were significantly shorter than those of ESD. ESD achieved a complete resection rate of 80.0% in the IMG. The tumor size did not affect the overall survival or rate of lymph node/distant metastases.

Conclusions

Endoscopic resection is a feasible and effective treatment for patients with rectal NETs < 15 mm without the risk factors of metastasis. ESMR-L and ESD are optimal techniques for resecting tumors smaller than 10 mm and 10–14 mm, respectively.

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Data availability

All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding authors.

References

  1. Gallo C, Rossi RE, Cavalcoli F et al. Rectal neuroendocrine tumors: current advances in management, treatment, and surveillance. World J Gastroenterol. 2022;28:1123–1138.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Osagiede O, Habermann E, Day C et al. Factors associated with worse outcomes for colorectal neuroendocrine tumors in radical versus local resections. J Gastrointest Oncol. 2020;11:836–846.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Wang XY, Chai NL, Linghu EQ et al. Efficacy and safety of hybrid endoscopic submucosal dissection compared with endoscopic submucosal dissection for rectal neuroendocrine tumors and risk factors associated with incomplete endoscopic resection. Ann Transl Med. 2020;8:368.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ploeckinger U, Kloeppel G, Wiedenmann B et al. The German NET-registry: an audit on the diagnosis and therapy of neuroendocrine tumors. Neuroendocrinology. 2009;90:349–363.

    Article  CAS  PubMed  Google Scholar 

  5. Dasari A, Shen C, Halperin D et al. Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol. 2017;3:1335–1342.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chang JS, Chen LT, Shan YS et al. An updated analysis of the epidemiologic trends of neuroendocrine tumors in Taiwan. Sci Rep. 2021;11:7881.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Scherübl H, Cadiot G. Early gastroenteropancreatic neuroendocrine tumors: endoscopic therapy and surveillance. Visc Med. 2017;33:332–338.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Basuroy R, O’Donnell CM, Srirajaskanthan R et al. Ileocolonic neuroendocrine tumours identified in the English bowel cancer screening programme. Colorectal Dis. 2018;20:O85–O91.

    Article  CAS  PubMed  Google Scholar 

  9. Dąbkowski K, Szczepkowski M, Kos-Kudła B et al. Endoscopic management of rectal neuroendocrine tumours. How to avoid a mistake and what to do when one is made? Endokrynol Pol 2020;71:343–349.

    Article  PubMed  Google Scholar 

  10. Chen HT, Xu GQ, Teng XD et al. Diagnostic accuracy of endoscopic ultrasonography for rectal neuroendocrine neoplasms. World J Gastroenterol. 2014;20:10470–10477.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ngamruengphong S, Kamal A, Akshintala V et al. Prevalence of metastasis and survival of 788 patients with T1 rectal carcinoid tumors. Gastrointest Endosc. 2019;89:602–606.

    Article  PubMed  Google Scholar 

  12. Kuiper T, van Oijen MGH, van Velthuysen MF et al. Endoscopically removed rectal NETs: a nationwide cohort study. Int J Colorectal Dis. 2021;36:535–541.

    Article  PubMed  Google Scholar 

  13. Matsuhashi N, Takahashi T, Tomita H et al. Evaluation of treatment for rectal neuroendocrine tumors sized under 20 mm in comparison with the WHO 2010 guidelines. Mol Clin Oncol. 2017;7:476–480.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ito T, Masui T, Komoto I et al. JNETS clinical practice guidelines for gastroenteropancreatic neuroendocrine neoplasms: diagnosis, treatment, and follow-up: a synopsis. J Gastroenterol. 2021;56:1033–1044.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Kunz PL, Reidy-Lagunes D, Anthony LB et al. Consensus guidelines for the management and treatment of neuroendocrine tumors. Pancreas. 2013;42:557–577.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ramage JK, De Herder WW, Delle Fave G et al. ENETS consensus guidelines update for colorectal neuroendocrine neoplasms. Neuroendocrinology. 2016;103:139–143.

    Article  CAS  PubMed  Google Scholar 

  17. Kulke MH, Shah MH, Benson AB 3rd et al. Neuroendocrine tumors, version 1.2015. J Natl Compr Canc Netw. 2015;13:78–108.

    Article  CAS  PubMed  Google Scholar 

  18. Park CH, Cheon JH, Kim JO et al. Criteria for decision making after endoscopic resection of well-differentiated rectal carcinoids with regard to potential lymphatic spread. Endoscopy. 2011;43:790–795.

    Article  CAS  PubMed  Google Scholar 

  19. de Mestier L, Brixi H, Gincul R et al. Updating the management of patients with rectal neuroendocrine tumors. Endoscopy. 2013;45:1039–1046.

    Article  PubMed  Google Scholar 

  20. Chida K, Watanabe J, Hirasawa K et al. A novel risk-scoring system for predicting lymph node metastasis of rectal neuroendocrine tumors. Ann Gastroenterol Surg. 2020;4:562–570.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Zheng X, Wu M, Er L et al. Risk factors for lymph node metastasis and prognosis in colorectal neuroendocrine tumours. Int J Colorectal Dis. 2022;37:421–428.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Rossi RE, Elvevi A, Gallo C et al. Endoscopic techniques for diagnosis and treatment of gastro-entero-pancreatic neuroendocrine neoplasms: Where we are. World J Gastroenterol. 2022;28:3258–3273.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hamada Y, Tanaka K, Tano S et al. Usefulness of endoscopic submucosal dissection for the treatment of rectal carcinoid tumors. Eur J Gastroenterol Hepatol. 2012;24:770–774.

    Article  PubMed  Google Scholar 

  24. Chen T, Yao LQ, Xu MD et al. Efficacy and safety of endoscopic submucosal dissection for colorectal carcinoids. Clin Gastroenterol Hepatol. 2016;14:575–581.

    Article  PubMed  Google Scholar 

  25. Lim HK, Lee SJ, Baek DH et al. Resectability of rectal neuroendocrine tumors using endoscopic mucosal resection with a ligation band device and endoscopic submucosal dissection. Gastroenterol Res Pract. 2019;2019:8425157.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Takita M, Sakai E, Nakao T et al. Clinical outcomes of patients with small rectal neuroendocrine tumors treated using endoscopic submucosal resection with a ligation device. Digestion 2019;99:72–78.

    Article  PubMed  Google Scholar 

  27. Park SB, Kim HW, Kang DH et al. Advantage of endoscopic mucosal resection with a cap for rectal neuroendocrine tumors. World J Gastroenterol. 2015;21:9387–9393.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Nagai T, Torishima R, Nakashima H et al. Saline-assisted endoscopic resection of rectal carcinoids: cap aspiration method versus simple snare resection. Endoscopy. 2004;36:202–205.

    Article  CAS  PubMed  Google Scholar 

  29. Chen R, Liu X, Sun S et al. Comparison of endoscopic mucosal resection with circumferential incision and endoscopic submucosal dissection for rectal carcinoid tumor. Surg Laparosc Endosc Percutan Tech. 2016;26:e56-61.

    Article  PubMed  Google Scholar 

  30. Zhang J, Liu M, Li H et al. Comparison of endoscopic therapies for rectal carcinoid tumors: Endoscopic mucosal resection with circumferential incision versus endoscopic submucosal dissection. Clin Res Hepatol Gastroenterol. 2018;42:24–30.

    Article  PubMed  Google Scholar 

  31. Meier B, Albrecht H, Wiedbrauck T et al. Full-thickness resection of neuroendocrine tumors in the rectum. Endoscopy. 2020;52:68–72.

    Article  PubMed  Google Scholar 

  32. Zhou X, **e H, **e L et al. Endoscopic resection therapies for rectal neuroendocrine tumors: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2014;29:259–268.

    Article  PubMed  Google Scholar 

  33. Hamada Y, Tanaka K, Hattori A et al. Clinical utility of endoscopic submucosal dissection using the pocket-creation method with a HookKnife and preoperative evaluation by endoscopic ultrasonography for the treatment of rectal neuroendocrine tumors. Surg Endosc. 2022;36:375–384.

    Article  PubMed  Google Scholar 

  34. Mashimo Y, Matsuda T, Uraoka T et al. Endoscopic submucosal resection with a ligation device is an effective and safe treatment for carcinoid tumors in the lower rectum. J Gastroenterol Hepatol. 2008;23:218–221.

    Article  PubMed  Google Scholar 

  35. Kim HH, Park SJ, Lee SH et al. Efficacy of endoscopic submucosal resection with a ligation device for removing small rectal carcinoid tumor compared with endoscopic mucosal resection: analysis of 100 cases. Dig Endosc. 2012;24:159–163.

    Article  PubMed  Google Scholar 

  36. Park SS, Kim BC, Lee DE et al. Comparison of endoscopic submucosal dissection and transanal endoscopic microsurgery for T1 rectal neuroendocrine tumors: a propensity score-matched study. Gastrointest Endosc. 2021;94:408-415.e402.

    Article  PubMed  Google Scholar 

  37. Brand M, Reimer S, Reibetanz J et al. Endoscopic full thickness resection vs. transanal endoscopic microsurgery for local treatment of rectal neuroendocrine tumors—a retrospective analysis. Int J Colorectal Dis. 2021;36:971–976.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank the medical staff members of the Department of Endoscopy at each participating hospital for their contributions to this study. We also thank Editage (www.editage.com) for their English language editing.

Funding

The authors did not receive any funding relevant to this article.

Author information

Author notes

  1. Yasuhiko Hamada and Kyosuke Tanaka have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Mie University Hospital, 2–174 Edobashi, Tsu, Mie, 514–8507, Japan

    Yasuhiko Hamada, Kyosuke Tanaka & Hayato Nakagawa

  2. Department of Endoscopy, Mie University Hospital, Tsu, Japan

    Kyosuke Tanaka

  3. Department of Gastroenterology, Suzuka General Hospital, Suzuka, Japan

    Katsumi Mukai

  4. Department of Pathology, Suzuka General Hospital, Suzuka, Japan

    Youichirou Baba

  5. Department of Gastroenterology, Municipal Yokkaichi Hospital, Yokkaichi, Japan

    Makoto Kobayashi & Shintaro Tominaga

  6. Department of Gastroenterology, Saiseikai Mastusaka General Hospital, Matsusaka, Japan

    Hiroyuki Kawabata & Shoma Sawai

  7. Department of Gastroenterology, Matsusaka General Hospital, Matsusaka, Japan

    Masabumi Kaneko

  8. Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan

    Shinya Sugimoto

  9. Department of Gastroenterology, Mie Prefectural Medical Center, Yokkaichi, Japan

    Hidekazu Inoue

  10. Department of Oncologic Pathology, Mie University Hospital, Tsu, Japan

    Maya Mimuro

  11. Department of Clinical Research Center, Mie University Hospital, Tsu, Japan

    Satoshi Tamaru

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  1. Yasuhiko Hamada
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Contributions

YH and KT designed the study; collected, analyzed, and interpreted the data; and drafted the manuscript. KM, YB, MK, ST, HK, SS, MK, SS, and HI collected the data. MM evaluated the pathological findings. ST provided guidance regarding the study design. HN supervised the study. All authors have reviewed the manuscript and approved the final draft.

Corresponding author

Correspondence to Kyosuke Tanaka.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interests.

Ethical approval

The study was approved by the Ethics Committee of Mie University Hospital on March 17, 2021 (approval number: H2020-185) and registered in the University Hospital Medical Network Clinical Trials Registration (UMIN000043210). The study was conducted in accordance with the approved protocol and ethical standards of the Declaration of Helsinki of 1964 and later amendments. Informed consent was obtained from the patients using the opt-out method.

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Hamada, Y., Tanaka, K., Mukai, K. et al. Efficacy of Endoscopic Resection for Rectal Neuroendocrine Tumors Smaller than 15 mm. Dig Dis Sci 68, 3148–3157 (2023). https://doi.org/10.1007/s10620-023-07914-4

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