The meaning of R1 resection after endoscopic removal of gastric, duodenal and rectal neuroendocrine tumors

Esposito, Gianluca; Dell'Unto, E.; Ligato, Irene; Marasco, Matteo; Panzuto, Francesco

doi:10.1080/17474124.2023.2242261

Cited by 7 publications

(3 citation statements)

References 62 publications

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“…In the French retrospective study by Gincul et al, a positive margin rate (R1) as high as 44% was found and, in particular, in the univariate analysis, no significant differences were reported between the resection techniques (EMR/EMR-C) or tumor sizes (whether <10 mm or 10–20 mm), suggesting that the major role in oncological radicality may be played by the resection technique itself instead of by the tumor size [ 17 ]. However, as recently reported, when dNENs < 20 mm are considered, the actual impact of a positive margin status itself (R1) on the risk of recurrence after endoscopic resection has yet to be clarified, since data regarding the statistical significance of this association seem to be contradictory among different studies [ 10 , 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…Among them, ESD allows a higher rate of complete resection, but it owns higher risk of bleeding and perforation and a longer procedure time as compared to the other methods. Which endoscopic technique should be preferred among the others is still not clear, and in the majority of the cases the choice depends on both the tumor’s features and the endoscopist’s expertise [ 10 ]. In this grey area, according to the most recent guidelines [ 8 ], endoscopic resection might be considered only in selected cases and generally for tumors smaller than 15 mm.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Resection for Duodenal Neuroendocrine Neoplasms between 10 and 20 mm—A Systematic Review and Meta-Analysis

Rossi,

Masoni,

Massironi

et al. 2024

JCM

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Background. The optimal management of duodenal neuroendocrine neoplasms (dNENs) sized 10–20 mm remains controversial and although endoscopic resection is increasingly performed instead of surgery, the therapeutic approach in this setting is not fully standardized. We performed a systematic review of the literature and a meta-analysis to clarify the outcomes of endoscopic resection for 10–20 mm dNENs in terms of efficacy (i.e., recurrence rate) and safety. Methods. A computerized literature search was performed using relevant keywords to identify pertinent articles published until January 2023. Results. Seven retrospective studies were included in this systematic review. The overall recurrence rate was 14.6% (95%CI 5.4–27.4) in 65 patients analyzed, without significant heterogeneity. When considering studies specifically focused on endoscopic mucosal resection, the recurrence rate was 20.5% (95%CI 10.7–32.4), without significant heterogeneity. The ability to obtain the free margin after endoscopic resection ranged between 36% and 100%. No complications were observed in the four studies reporting this information. Conclusions. Endoscopic resection could be the first treatment option in patients with dNENs sized 10–20 mm and without evidence of metastatic disease. Further studies are needed to draw more solid conclusions, particularly in terms of superiority among the available endoscopic techniques.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic Resection for Duodenal Neuroendocrine Neoplasms between 10 and 20 mm—A Systematic Review and Meta-Analysis

Rossi,

Masoni,

Massironi

et al. 2024

JCM

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“…Excharcou et al reported a rate of complete endoscopic resection (R0) for type 3 gNETs using EMR or ESD of 72–80%, with the highest values obtained using the ESD technique ( 8 ); whereas Min et al obtained a rate of R0 resection in 86.4% of the cases, using primarily ESD but also EMR/modified-EMR ( 15 ). However, the optimum endoscopic resection approach in this situation is still debated, despite the fact that ESD appears to be the most successful ( 17 ).…”

Section: Management Of Type 3 Gnetsmentioning

confidence: 99%

Type 3 gastric neuroendocrine neoplasms: the rising promise of conservative endoscopic management

Dell’Unto,

Esposito,

Rinzivillo

et al. 2024

Front. Med.

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Gastric neuroendocrine neoplasms (g-NENs) are rare tumors arising from the gastric enterochromaffin-like cells. Recent data suggests an increased detection rate, attributed to more frequent esophagogastroduodenoscopies. While type 3 g-NENs were historically deemed aggressive, emerging research indicates potential for conservative management, especially endoscopic resection, in well-differentiated, small tumors. European guidelines now advocate for endoscopic intervention in selected cases, but North American guidelines remain more conservative. Key factors influencing outcomes are tumor size, grading, and depth of gastric wall infiltration. Endoscopic resection has shown promise for tumors confined to submucosal layers without lymphovascular invasion. Given the complexities, a multidisciplinary team approach is essential for management decisions. Current insights are largely based on retrospective studies, underscoring the need for prospective research to optimize endoscopic approaches.

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Endoscopic management of gastric, duodenal and rectal NETs: Position paper from the Italian Association for Neuroendocrine Tumors (Itanet), Italian Society of Gastroenterology (SIGE), Italian Society of Digestive Endoscopy (SIED)

Panzuto,

Parodi,

Esposito

et al. 2024

Digestive and Liver Disease

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The meaning of R1 resection after endoscopic removal of gastric, duodenal and rectal neuroendocrine tumors

Cited by 7 publications

References 62 publications

Endoscopic Resection for Duodenal Neuroendocrine Neoplasms between 10 and 20 mm—A Systematic Review and Meta-Analysis

Endoscopic Resection for Duodenal Neuroendocrine Neoplasms between 10 and 20 mm—A Systematic Review and Meta-Analysis

Type 3 gastric neuroendocrine neoplasms: the rising promise of conservative endoscopic management

Endoscopic management of gastric, duodenal and rectal NETs: Position paper from the Italian Association for Neuroendocrine Tumors (Itanet), Italian Society of Gastroenterology (SIGE), Italian Society of Digestive Endoscopy (SIED)

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