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Clinical outcomes of endoscopic mucosal resection for rectal neuroendocrine tumor

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Authors
Kim, Jihye; Kim, Jee Hyun; Lee, Joo Young; Chun, Jaeyoung; Im, Jong Pil; Kim, Joo Sung
Issue Date
2018-06-05
Publisher
BioMed Central
Citation
BMC Gastroenterology, 18(1):77
Keywords
Neuroendocrine tumorRectumEndoscopic mucosal resectionEfficacyPrognosis
Abstract
Background
The incidence of rectal neuroendocrine tumors (NETs) is rapidly increasing because of the frequent use of endoscopic screening for colorectal cancers. However, the clinical outcomes of endoscopic resection for rectal NETs are still unclear. The aim of this study was to assess the rates of histologically complete resection (H-CR) and recurrence after endoscopic mucosal resection (EMR) for rectal NETs.

Methods
A retrospective analysis was performed on patients who underwent EMR for rectal NETs between January 2002 and March 2015 at Seoul National University Hospital. Primary outcomes were H-CR and recurrence rates after endoscopic resection. H-CR was defined as the absence of tumor invasion in the lateral and deep margins of resected specimens.

Results
Among 277 patients, 243 (88%) were treated with conventional EMR, 23 (8%) with EMR using a dual-channel endoscope, and 11 (4%) with EMR after precutting. The median tumor size was 4.96 mm (range, 1–22) in diameter, and 264 (95%) lesions were confined to the mucosa and submucosal layer. The en-bloc resection rate was 99% and all patients achieved endoscopically complete resection. The H-CR rates were 75, 74, and 73% for conventional EMR, EMR using a dual-channel endoscope, and EMR after precutting, respectively. Multivariate analysis showed that H-CR was associated with tumor size regardless of endoscopic treatment modalities (p = 0.023). Of the 277 patients, 183 (66%) underwent at least 1 endoscopic follow-up. Three (2%) of these 183 patients had tumor recurrence, which was diagnosed at a median of 62.5 months (range 19–98) after endoscopic resection. There was 1 case of disease-related death, which occurred 167 months after endoscopic treatment because of bone marrow failure that resulted from tumor metastasis.

Conclusions
Although the en-bloc resection rate was 99% in rectal NETs, H-CR rates were 72–74% for various EMR procedures. H-CR may be associated with tumor size regardless of endoscopic treatment modalities.
ISSN
1471-230X
Language
English
URI
http://hdl.handle.net/10371/142757
DOI
https://doi.org/10.1186/s12876-018-0806-y
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College of Medicine/School of Medicine (의과대학/대학원)Internal Medicine (내과학전공)Journal Papers (저널논문_내과학전공)
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