Excellent prognosis following endoscopic resection of patients with rectal neuroendocrine tumors despite the frequent presence of lymphovascular invasion

Sekiguchi, Masau; Sekine, Shigeki; Sakamoto, Taku; Otake, Yosuke; Nakajima, Takeshi; Matsuda, Takahisa; Taniguchi, Hirokazu; Kushima, Ryoji; Ohe, Yuichiro; Saito, Yutaka

doi:10.1007/s00535-015-1079-7

Cited by 65 publications

(80 citation statements)

References 41 publications

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“…Recently, immunohistochemical staining has been increasingly used for the accurate diagnosis of lymphovascular invasion [26][27][28]. Sekiguchi et al [28] retrospectively revealed that immunohistochemical staining identified almost half of the rectal NETs with lymphovascular invasion, while routine H-E staining identified only 1.2% in the same sample. Of note, although these patients did not undergo additional surgery, neither nodal nor distant metastasis occurred.…”

Section: Discussionmentioning

confidence: 99%

“…Although additional surgery should be considered in patients with rectal NETs harboring lymphovascular invasion, this approach needs further validation because the reported prevalence of lymphovascular invasion ranges widely from approximately 1% to a little less than 60% [14,26]. Recently, immunohistochemical staining has been increasingly used for the accurate diagnosis of lymphovascular invasion [26][27][28]. Sekiguchi et al [28] retrospectively revealed that immunohistochemical staining identified almost half of the rectal NETs with lymphovascular invasion, while routine H-E staining identified only 1.2% in the same sample.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Outcomes of Patients with Small Rectal Neuroendocrine Tumors Treated Using Endoscopic Submucosal Resection with a Ligation Device

et al. 2018

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Background/Aims: The therapeutic strategies for small rectal neuroendocrine tumors (NETs) have not been standardized. We examined the efficacy and safety of endoscopic submucosal resection with a ligation device (ESMR-L) and the long-term outcomes after endoscopic treatment. Methods: A total of 181 patients with rectal NETs <10 mm who were treated between May 2002 and May 2017 were retrospectively enrolled. All the lesions had been resected using ESMR-L, and the follow-up strategies were determined according to the pathological examinations. The long-term outcomes after a 53-month follow-up period were also evaluated. Results: R0 resection was achieved in 180 cases (99.4%). Lymphovascular invasion was confirmed in 67 cases (37.0%), while a curative resection was achieved in 114 cases (63.0%). One perforation (0.6%) and 11 cases with delayed bleeding (6.1%) were observed. A multivariate logistic regression analysis revealed that a tumor size > 5 mm (OR 2.06; 95% CI 1.04–4.08, p = 0.04) was a significant independent predictor of the presence of lymphovascular invasion. Of the 67 patients with non-curative resections, 11 patients underwent additional surgery; lymph node metastasis was confirmed in 2 cases (18.2%). No local or distant metastases were observed during the follow-up period in 77 patients with a curative resection, 9 patients who received additional surgery, and 50 patients with non-curative resections. Conclusion: ESMR-L is an easy, safe and effective treatment for rectal NETs <10 mm in diameter, and the prognosis of patients seems to be good, despite a relatively high rate of lymphovascular invasion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Patients with Small Rectal Neuroendocrine Tumors Treated Using Endoscopic Submucosal Resection with a Ligation Device

et al. 2018

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“…Park et al [16] reported that the 3-year survival rate was 100% among patients with RNETs ≤10 mm following ER. In addition, Sekiguchi et al [26] reported that 90 RNETs treated endoscopically were followed up without additional surgery, and no metastasis or recurrence was detected during the median follow-up period of 67.5 months despite the presence of LVI in nearly half of the lesions. These results showed an excellent prognosis following ER in patients with small RNETs.…”

Section: Clinical Outcomes Following Ermentioning

confidence: 99%

“…Sekiguchi et al [26] reported the frequent presence of LVI in small RNETs using immunohistochemical analysis (46.7%). Almost all the lesions were smaller than 10 mm in size, fulfilling the criteria for the application of ER.…”

Section: Lymphovascular Invasion In Small Rnetsmentioning

confidence: 99%

“…3). Moreover, because NET tumor cells exhibit minute cytological atypia, unlike most other malignant neoplasms, tumor cells within small vessels are often difficult to identify [26]. Because of this unique pathological character of RNETs and the limitation of the HE stain, additional immunohistochemical analysis will be required to accurately identify LVI in small RNETs.…”

Section: Lymphovascular Invasion In Small Rnetsmentioning

confidence: 99%

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Frequent Presence of Lymphovascular Invasion in Small Rectal Neuroendocrine Tumors on Immunohistochemical Analysis

Kitagawa

Ikebe²,

Suzuki³

et al. 2017

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Rectal neuroendocrine tumors (RNETs) have become common in recent years and are good candidates for endoscopic resection (ER). To achieve clear resection margins, more advanced techniques such as endoscopic submucosal dissection, endoscopic submucosal resection with a ligation device, and cap-assisted endoscopic mucosal resection are available for ER. After ER, lymphovascular invasion (LVI) is regarded as an important predictor of nodal metastasis. Previous studies have shown that small RNETs with LVI were uncommon (0-8.3%). However, using immunohistochemical analysis, a recent study revealed the frequent occurrence of LVI in small RNETs in a systematic manner (46.7%). There is a possibility that the actual detection rate of LVI in small RNETs is not always evaluated accurately because of the limited detection sensitivity of conventional hematoxylin-eosin staining. In addition, the correlation between LVI detected using immunohistochemical analysis and the development of metastasis remains unclear. Further prospective studies are required to clarify the role of LVI detected using immunohistochemical analysis.

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A novel risk‐scoring system for predicting lymph node metastasis of rectal neuroendocrine tumors

Chida

Watanabe

Hirasawa

et al. 2020

Annals of Gastroent Surgery

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Excellent prognosis following endoscopic resection of patients with rectal neuroendocrine tumors despite the frequent presence of lymphovascular invasion

Cited by 65 publications

References 41 publications

Clinical Outcomes of Patients with Small Rectal Neuroendocrine Tumors Treated Using Endoscopic Submucosal Resection with a Ligation Device

Clinical Outcomes of Patients with Small Rectal Neuroendocrine Tumors Treated Using Endoscopic Submucosal Resection with a Ligation Device

Frequent Presence of Lymphovascular Invasion in Small Rectal Neuroendocrine Tumors on Immunohistochemical Analysis

A novel risk‐scoring system for predicting lymph node metastasis of rectal neuroendocrine tumors

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