Full-thickness resection of neuroendocrine tumors in the rectum

Abstract

Background Rectal neuroendocrine tumors (NETs) are subepithelial tumors with potential for malignancy. Depending on tumor characteristics, endoscopic or surgical resection is recommended. However, the optimal endoscopic approach is not defined. This is the first larger study evaluating endoscopic full-thickness resection (EFTR) of rectal NETs. Methods For resection, the full-thickness resection device (FTRD) was used. A registry was created as part of post-market clinical follow-up. All cases of rectal NETs in the registry were analyzed retrospectively. Results 31 German centers entered data of 501 FTRD procedures and 40 cases of rectal NETs were identified. The median lesion size was 8 mm. All lesions could be resected using FTRD. The median procedure time was 18.5 minutes. Resection was macroscopically and histologically complete in all cases. Full-thickness resection was achieved in 95 %. No major adverse events occurred. Endoscopic follow-up showed no evidence of residual or recurrent tumor. Conclusion EFTR is safe and effective for resection of smaller rectal NETs. Prospective comparative trials are needed to define the role of EFTR of rectal NETs.

Technical success, resection status, and procedural complication rate of colonoscopic full-wall resection: a pooled analysis from 7 hospitals of different care levels

“…This novel and relatively simple endoscopic technique allows effective treatment of, e.g., difficult colorectal lesions and may become an alternative to surgery in selected patients [14]. To date, eFTR has been successfully performed in different regions of the gastrointestinal tract apart from the colorectum such as stomach and small intestine [15][16][17][18][19].…”

Endoscopic full thickness resection vs. transanal endoscopic microsurgery for local treatment of rectal neuroendocrine tumors - a retrospective analysis

“…The full-thickness resection device (FTRD; Ovesco Endoscopy, Tuebingen, Germany) was attached at the tip of the endoscope and resection of rectal NET was performed as previously described ( Fig. 1) [9,10].…”

“…A recent publication reported excellent R0 rates, using eFTR for rectal NET treatment. However, data comparing eFTR with other techniques is still missing [9]. In this study, we aim to analyze the outcome of eFTR and TEM in local treatment of rectal NETs.…”

Endoscopic management of rectal neuroendocrine tumours. How to avoid a mistake and what to do when one is made?

“…Recently, a new method of endoscopic treatment for colorectal tumours was presented, with the use of an endoscopic full-thickness resection device (FTRD) [26,27]. The study by Meyer et al on 40 patients with rectal NENs showed not only the feasibility (median time, 18.5 min) and safety (no major adverse events), but also the effectiveness of this method (R0 resection rate in 95%) [26].…”

“…Recently, a new method of endoscopic treatment for colorectal tumours was presented, with the use of an endoscopic full-thickness resection device (FTRD) [26,27]. The study by Meyer et al on 40 patients with rectal NENs showed not only the feasibility (median time, 18.5 min) and safety (no major adverse events), but also the effectiveness of this method (R0 resection rate in 95%) [26]. Moreover, in all reported case reports of rNEN, FTR showed its effectiveness and safety, both for the treatment of primary rectal NEN and as a salvage therapy after polypectomy [28][29][30].…”