Long-Term Clinical Outcomes of Rectal Neuroendocrine Tumors According to the Pathologic Status After Initial Endoscopic Resection: A KASID Multicenter Study

Moon, Chang Mo; Huh, Kyu Chan; Jung, Sung Ae; Park, Dong Il; Kim, Wonhee; Jung, Hye Mi; Koh, Seong‐Joon; Kim, Jin Oh; Jung, Yunho; Kim, Kyeong Ok; Kim, Jong Wook; Yang, Dong Hoon; Shin, Jeong Eun; Shin, Sung Jae; Kim, Eun Soo; Joο, Young Eun

doi:10.1038/ajg.2016.267

Cited by 51 publications

(37 citation statements)

References 32 publications

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“…According to the current guidelines, lesions considered to be histologically non-curatively resected after ER must undergo additional salvage treatments 11 . However, the majority of patients with non-curative resection did not undergo additional salvage treatments 20 . The reason for patients not receiving additional treatments is that positive resection margins are not always predictive factors of remnant tumor, recurrence, or metastasis and that patients or clinicians decide to choose regular follow-up through colonoscopy and biopsy rather than salvage treatments.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes according to additional treatments after endoscopic resection for rectal small neuroendocrine tumors

Hwang

Jung

Kim

et al. 2019

Sci Rep

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The present study aimed to investigate treatment strategies determining additional treatment after endoscopic resection (ER) of rectal neuroendocrine tumor (NET)s and long-term outcomes of endoscopically resected rectal NETs. We analyzed a total of 322 patients medical records of patients who underwent ER for rectal NETs. Rectal NETs initially resected as polyps and treated with conventional endoscopic mucosal resection (EMR) were observed more frequently in the non-curative group (P = 0.041 and P = 0.012, respectively). After ER, only 44 of the 142 patients (31.0%) who did not meet the criteria for curative resection received additional salvage treatment. In multivariate analysis, lesions diagnosed via biopsies (OR, 0.096; P = 0.002) or suspected as NETs initially (OR, 0.04; P = 0.001) were less likely to undergo additional treatment. Positive lymphovascular invasion (OR 61.971; P < 0.001), positive (OR 75.993; P < 0.001), or indeterminate (OR 13.203; P = 0.001) resection margins were more likely to undergo additional treatment. Although lymph node metastasis was found in 6 patients, none experienced local or metastatic tumor recurrence during the median follow-up of 40.49 months. Long-term outcomes after ER for rectal NETs were excellent. The prognosis showed favorable outcomes regardless of whether patients receive additional salvage treatments.

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Section: Discussionmentioning

confidence: 99%

Long-term outcomes according to additional treatments after endoscopic resection for rectal small neuroendocrine tumors

Hwang

Jung

Kim

et al. 2019

Sci Rep

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“…For this reason, and because of the extremely low risk of lymph node metastasis, local excision is considered to be a sufficient treatment for lesions less than 10 mm in diameter [ 5 ]. However, there are currently no widely used guidelines regarding the management of rectal NETs 10–20 mm in diameter [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recent study revealed that synchronous rectal NET at the initial diagnosis was associated with the development of development of metachronous rectal NETs [ 17 ]. Similar results were found in studies of colorectal adenoma.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of endoscopic mucosal resection for rectal neuroendocrine tumor

Kim

Lee

et al. 2018

BMC Gastroenterol

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BackgroundThe 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.MethodsA 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.ResultsAmong 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.ConclusionsAlthough 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.

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“…Moon et al [14] reported that 7 of the 148 patients showed positive margins and therefore needed additional treatment. In patients with long-term follow-up with positive margins following endoscopic treatment without additional treatment, the local recurrence rate was 1.4% (2/141).…”

Section: Discussionmentioning

confidence: 99%

Pocket Creation Method of Endoscopic Submucosal Dissection to Ensure Curative Resection of Rectal Neuroendocrine Tumors

Kobori

Katayama

Kitagawa

et al. 2018

GE Port J Gastroenterol

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Purpose: Pancreatic/gastrointestinal tract neuroendocrine neoplasm (NEN) is divided into neuroendocrine tumor (NET) and neuroendocrine carcinoma (NEC) according to the grade of malignancy, and differences are seen in clinical prognosis. NET, and rectal NET in particular, is often treated endoscopically. Endoscopic mucosal resection (EMR) was previously the main intervention for rectal NET, but EMR with a ligation device (EMR-L) and endoscopic submucosal dissection (ESD) are now also used. However, complete resection with these therapies is not always achieved. The pocket creation method (PCM) is a safe ESD method for colon tumors that offers a high en bloc resection rate compared with conventional colonic ESD. We performed ESD using the PCM for rectal NET and evaluated the complete resection rate. Methods: We performed ESD using the PCM in 4 patients. This procedure was technically feasible in all patients. Results: Endoscopically, all cases were resected en bloc, and pathological complete resection was achieved in all cases. No complications such as perforation or delayed postoperative bleeding were encountered. Conclusions: PCM should be considered when treating NET of appropriate size.

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Long-Term Clinical Outcomes of Rectal Neuroendocrine Tumors According to the Pathologic Status After Initial Endoscopic Resection: A KASID Multicenter Study

Cited by 51 publications

References 32 publications

Long-term outcomes according to additional treatments after endoscopic resection for rectal small neuroendocrine tumors

Long-term outcomes according to additional treatments after endoscopic resection for rectal small neuroendocrine tumors

Clinical outcomes of endoscopic mucosal resection for rectal neuroendocrine tumor

Pocket Creation Method of Endoscopic Submucosal Dissection to Ensure Curative Resection of Rectal Neuroendocrine Tumors

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