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Risk of lymph node metastasis after endoscopic treatment for rectal NETs 10 mm or less

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

For rectal neuroendocrine tumors (NETs) ≤ 10 mm, endoscopic resection is a standard treatment. However, there is no consensus whether additional surgery should be performed for patients at risk of lymph node metastasis (LNM) after endoscopic resection. The purpose of this study was to analyze the results of endoscopic resection and additional surgery of rectal NETs, thereby clarify the characteristics of cases with LNM.

Methods

This study was a multicenter retrospective cohort study conducted at 12 Japanese institutions. A total of 132 NETs ≤ 10 mm were analyzed regarding various therapeutic results. A comparative analysis was performed by dividing the cases into two groups that underwent additional surgery or not. Furthermore, the relationship between tumor size and LNM was examined.

Results

The endoscopic treatments were 12 endoscopic mucosal resections (EMR), 58 endoscopic submucosal resections with ligation (ESMR-L), 29 precutting EMRs, and 33 endoscopic submucosal dissections (ESD). The R0 resection rates of EMR were 41.7%, and compared to this rate, other three treatments were 86.2% (p < 0.001), 86.2% (p = 0.005), and 97.0% (p < 0.001), respectively. There were 41 non-curative cases (31.1%), and 13 had undergone additional surgery. Then, LNM was observed in 4 of the 13 patients, with an overall rate of LNM of 3.0% (4/132). The rate of positive lymphatic invasion and the rate of LNM by tumor size ≤ 6 mm and 7–10 mm were 9.7 vs. 15.4% (p = 0.375) and 0 vs. 10.3% (p = 0.007).

Conclusions

A multicenter study revealed the priority of each endoscopic resection and the low rate of LNM for rectal NETs ≤ 6 mm.

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Acknowledgments

We thank Dr. Ritsu Yasuda, Dr. Satoshi Sugino, Dr. Dr. Rafiz Abdul Rani, and all members of the Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, for hel** with this study.

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Authors and Affiliations

  1. Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan

    Yutaka Inada

  2. Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Naohisa Yoshida, Ryohei Hirose, Ken Inoue, Osamu Dohi & Yoshito Itoh

  3. Department of Gastroenterology, Nara City Hospital, Nara, Japan

    Kohei Fukumoto

  4. Department of Gastroenterology, Kyoto Kuramaguchi Medical Center, Kyoto, Japan

    Takaaki Murakami

  5. Department of Gastroenterology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan

    Kiyoshi Ogiso

  6. Department of Gastroenterology, Saiseikai Kyoto Hospital, Kyoto, Japan

    Akira Tomie

  7. Department of Gastroenterology, Akashi City Hospital, Akashi, Hyogo, Japan

    Munehiro Kugai

  8. Department of Gastroenterology, Otsu City Hospital, Otsu, Shiga, Japan

    Hiroyuki Yoriki

  9. Department of Gastroenterology, Nishi** Hospital, Kyoto, Japan

    Yoshikazu Inagaki

  10. Department of Gastroenterology, Ayabe City Hospital, Kyoto, Japan

    Daisuke Hasegawa

  11. Department of Gastroenterology, Kyoto Kujo Hospital, Kyoto, Japan

    Kotaro Okuda

  12. Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto, Japan

    Takashi Okuda

  13. Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan

    Yukiko Morinaga & Mitsuo Kishimoto

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  1. Yutaka Inada
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  2. Naohisa Yoshida
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  18. Yoshito Itoh
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Corresponding author

Correspondence to Naohisa Yoshida.

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Conflict of interest

Naohisa Yoshida received a research grant from Fujifilm Co. The other authors have no conflicts of interest to declare.

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Inada, Y., Yoshida, N., Fukumoto, K. et al. Risk of lymph node metastasis after endoscopic treatment for rectal NETs 10 mm or less. Int J Colorectal Dis 36, 559–567 (2021). https://doi.org/10.1007/s00384-020-03826-1

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  • DOI: https://doi.org/10.1007/s00384-020-03826-1

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