Nodal metastases in small rectal neuroendocrine tumours

O’Neill, Sarah; Haji, Amyn; Ryan, Suzanne M.; Clement, Dominique; Sarras, Konstantinos; Hayee, Bu; Mulholland, Nicola; Srirajaskanthan, Rajaventhan

doi:10.1111/codi.15978

Cited by 10 publications

(8 citation statements)

References 22 publications

(28 reference statements)

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“…Furthermore, longer follow-up period of incomplete resection without additional treatment is warranted for the assessment of long-term prognosis. Fourth, we only used CT scans for staging and followup rather than MRI or Gallium-68 PET/CT, which may be more sensitive to detect small recurrences or small volume of metastatic disease [13]. Despite these limitations, to the best of our knowledge, our study is the first to demonstrate a good prognosis without performing additional resection in a pathological incompletely resected small rectal NET.…”

Section: Discussionmentioning

confidence: 99%

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Prognosis of incompletely resected small rectal neuroendocrine tumor using endoscope without additional treatment

Cha

Shin

et al. 2022

BMC Gastroenterol

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Background In recent years, the incidence of rectal neuroendocrine tumors (NET)s has markedly increased due to the widespread use of screening colonoscopy. However, many patients are referred from local clinics after undergoing conventional endoscopic mucosal resection (EMR) for polyps without perceived NET, with a pathological report of incomplete resection. We evaluated the prognosis of incompletely resected small rectal NET without additional endoscopic resection for small rectal NET less than 10 mm in diameter present within the submucosal layer showing good prognosis, due to its rare metastatic potential. Methods We retrospectively reviewed patients from 2008 to 2018 at a single center who had had small rectal NET (located in the rectum from the anal verge to 20 cm in proximity) and had undergone ‘incomplete resection’ using endoscopy with a positive deep margin or with a very small safe deep margin (< 100 um). A small rectal NET was defined as a tumor ≤ 10 mm in diameter, without lymph node nor distant metastasis, and with low grade (G1) according to the WHO grading system. Results Of 267 patients who were diagnosed with small rectal NET, 77 were diagnosed with incomplete resection or possible remnant NET. Of those, 55 patients (55/77, 71.4%) were referred from local clinics post EMR diagnosed as polyps. The rate of histologically incomplete resection was highest in endoscopic submucosal dissection (11/21, 52.4%) and lowest in surgical resection (0/9, 0%), while endoscopic submucosal resection with band ligation showed an incomplete resection rate of 4.4% (5/113). After exclusion of 36 patients, namely 21 patients had undergone additional surgical (n = 6) or endoscopic (n = 15) resection and 25 patients who were lost during the follow-up period of 2 years, 31 patients had undergone surveillance with endoscopic evaluation or either a biopsy or radiological evaluation for distant metastasis during a median follow-up duration of 2 years. None of the incompletely resected small rectal NET patients showed local or distant metastasis. Conclusion Incomplete resection of small rectal NET with G1 grade has a good prognosis without additional treatment.

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Section: Discussionmentioning

confidence: 99%

“…European guidelines recommended annual follow-up in perpetuity in case of incomplete resection of G1 grade tumors less than 10 mm in diameter, and within mucosa or submucosa [13]. A newly updated NCCN guideline recommended a 6-to 12-month follow-up for incompletely resected G1 grade tumors ≤ 10 mm in diameter.…”

Section: Introductionmentioning

confidence: 99%

Prognosis of incompletely resected small rectal neuroendocrine tumor using endoscope without additional treatment

Cha

Shin

et al. 2022

BMC Gastroenterol

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“…As mentioned above risk for lymph node or distant metastases is very low after endoscopic removal of T1/G1‐NET <10 mm 33,47 . However, there is no definite lower limit of size that excludes lymph node spread 48 …”

Section: Introductionmentioning

confidence: 98%

“…33,47 However, there is no definite lower limit of size that excludes lymph node spread. 48 Techniques that are used to remove rectal NETs:…”

Section: Introductionmentioning

confidence: 99%

European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for colorectal neuroendocrine tumours

Rinke

Ambrosini

Dromain

et al. 2023

J Neuroendocrinology

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This ENETS guidance paper, developed by a multidisciplinary working group, provides an update on the previous colorectal guidance paper in a different format. Guided by key clinical questions practical advice on the diagnosis and management of neuroendocrine tumours (NET) of the caecum, colon, and rectum is provided. Although covered in one guidance paper colorectal NET comprises a heterogeneous group of neoplasms. The most common rectal NET are often small G1 tumours that can be treated by adequate endoscopic resection techniques. Evidence from prospective clinical trials on the treatment of metastatic colorectal NET is limited and discussion of patients in experienced multidisciplinary tumour boards strongly recommended.Neuroendocrine carcinomas (NEC) and mixed neuroendocrine non-neuroendocrine neoplasms (MiNEN) are discussed in a separate guidance paper.

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“…When the initial resection is not R0, the question of local and distant recurrence risk remains. Guidelines recommend perpetual annual follow-up in these cases (7). Hence, endoscopic re-evaluation with the aim of completely removing all residual r-NET cells might alleviate the burden of perpetual follow-up.…”

Section: Introductionmentioning

confidence: 99%

Systematic Resection of the Visible Scar After Incomplete Endoscopic Resection of Rectal Neuroendocrine Tumors

Cheminel,

Lupu,

Wallenhorst

et al. 2023

Am J Gastroenterol

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Background and aims: When initial resection of Rectal Neuroendocrine tumours (r-NET) is not R0, persistence of local residue could lead to disease recurrence. This study aimed to evaluate the interest of systematic resection of non-R0 r-NET scars. Methods: Retrospective analysis of all the consecutive endoscopic revisions and resections of the scar after non-R0 resections of r-NETs. Results: 100 patients were included. Salvage endoscopic procedure using ESD or EFTR showed a R0 rate of near 100%. Residual r-NET was found in 43% of cases. Conclusions: In case of non-R0 resected r-NET, systematic scar resection by EFTR or ESD seems necessary.

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Nodal metastases in small rectal neuroendocrine tumours

Cited by 10 publications

References 22 publications

Prognosis of incompletely resected small rectal neuroendocrine tumor using endoscope without additional treatment

Prognosis of incompletely resected small rectal neuroendocrine tumor using endoscope without additional treatment

European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for colorectal neuroendocrine tumours

Systematic Resection of the Visible Scar After Incomplete Endoscopic Resection of Rectal Neuroendocrine Tumors

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