Clinical study of different endoscopic resection methods in the treatment of rectal neuroendocrine tumors

doi:10.3877/cma.j.issn.2095-7157.2023.03.006

Abstract

Abstract:

Objective

To retrospectively analyze the safety and efficacy of conventional-endoscopic mucosal resection(c-EMR), modified-endoscopic mucosal resection (m-EMR) and endoscopic submucosal dissection (ESD) in the treatment of <10 mm and ≥10 mm rectal neuroendocrine tumor (R-NEN).

Methods

The total of 120 patients with R-NEN confirmed by postoperative pathological results who receive treatment in the Gastrointestinal Center of Northern Jiangsu People′s Hospital from May 2012 to May 2022 were selected as the study subjects. We retrospectively analyzed the en bloc resection rate, histological complete resection, operative complication, and time of different endoscopic procedures.

Results

A total of 120 patients were included, of which 24 underwent c-EMR, 30 underwent m-EMR and 66 underwent ESD.There were 79 patients in the diameter<10 mm group, 16 patients underwent c-EMR, 18 patients underwent m-EMR, 45 patients underwent ESD. There were no significant differences in the en bloc resection rate and histological complete resection among the three groups (P>0.05). There were 41 patients in the diameter ≥10 mm group, 8 patients underwent c-EMR, 12 patients underwent m-EMR, 21 patients underwent ESD. The histological resection rate of m-EMR and ESD group was higher than that of c-EMR group, and the difference was statistically significant (P<0.05). The operation time of c-EMR and m-EMR group was shorter than that of ESD group among patients in the diameter <10 mm group and ≥10 mm group.

Conclusion

C-EMR, m-EMR and ESD can effectively and safely resect R-NEN with tumor diameter <10mm, but m-EMR and ESD are recommended for ≥10 mm tumors. Follow-up is still important no matter which endoscopic procedure was chosen.

Key words: Rectal neuroendocrine neoplasm, Endoscopic mucosal resection, Modified-endoscopic mucosal resection, Endoscopic submucosal dissection

Xiufan Ni, Lei Chen, Jian Yin, Li Zhang, Sujun Gao, Zhen Zhu. Clinical study of different endoscopic resection methods in the treatment of rectal neuroendocrine tumors[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2023, 10(03): 173-179.

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Figures/Tables 7

References 23

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指标	总体	c-EMR组	m-EMR组	ESD组
性别
男	69(57.5)	14(58.3)	16(53.3)	39(59.1)
女	51(42.5)	10(41.7)	14(46.7)	27(40.9)
年龄(岁，±s)	53.88±11.03	52.83±11.07	49.03±10.93	56.47±10.40
手术例术(n)	120	24	30	66
<10 mm	79	16	18	45
≥10 mm	41	8	12	21
肿瘤大小(mm，±s)	7.99±3.40	8.42±3.31	7.57±2.91	7.99±3.40
<10 mm	5.96±1.59	6.59±1.93	5.56±1.81	5.92±1.33
≥10 mm	11.88±2.42	12.13±2.10	10.58±0.90	12.52±2.87
肿瘤距肛缘距离(cm，±s)	6.55±2.33	6.29±2.01	6.20±2.04	6.80±2.56
<10 mm	6.62±2.40	6.44±2.13	5.67±2.00	7.07±2.56
≥10 mm	11.88±2.42	12.13±2.10	10.58±0.90	12.52±2.87
肿瘤病理分期(n)
G1	114	22	30	62
G2	6	2	0	4
G3	0	0	0	0

指标	总体	c-EMR组	m-EMR组	ESD组
性别
男	69(57.5)	14(58.3)	16(53.3)	39(59.1)
女	51(42.5)	10(41.7)	14(46.7)	27(40.9)
年龄(岁，±s)	53.88±11.03	52.83±11.07	49.03±10.93	56.47±10.40
手术例术(n)	120	24	30	66
<10 mm	79	16	18	45
≥10 mm	41	8	12	21
肿瘤大小(mm，±s)	7.99±3.40	8.42±3.31	7.57±2.91	7.99±3.40
<10 mm	5.96±1.59	6.59±1.93	5.56±1.81	5.92±1.33
≥10 mm	11.88±2.42	12.13±2.10	10.58±0.90	12.52±2.87
肿瘤距肛缘距离(cm，±s)	6.55±2.33	6.29±2.01	6.20±2.04	6.80±2.56
<10 mm	6.62±2.40	6.44±2.13	5.67±2.00	7.07±2.56
≥10 mm	11.88±2.42	12.13±2.10	10.58±0.90	12.52±2.87
肿瘤病理分期(n)
G1	114	22	30	62
G2	6	2	0	4
G3	0	0	0	0

项目	c-EMR组	m-EMR组	ESD组	P值
手术例数(n)	24	30	66
<10 mm	16	18	45
≥10 mm	8	12	21
成功切除率	22/24(91.7)	29/30(96.7)	64/66(97.0)	0.492
<10 mm	15/16(93.8)	18/18(100)	44/45(97.8)	0.416
≥10 mm	7/8(87.5 )	11/12(91.7)	20/21(95.2)	0.764
完整切除率	13/24(54.2)	26/30(86.7)^a	58/66(87.9)^a	0.001
<10 mm	11/16(68.8)	16/18(88.9)	40/45(88.9)	0.178
≥10 mm	2/8(25.0)	10/12(83.3)^a	18/21(85.7)^a	0.004
手术时间(min，±s)	14.92±1.53	15.2±2.11	26.56±4.29^ab	<0.001
<10 mm	15.5±0.89	15.17±2.12	26.22±4.55^ab	<0.001
≥10 mm	13.75±1.91	15.25±2.18	27.29±3.65^ab	<0.001
住院天数(d，±s)	2.54±1.06	3.07±2.50	4.08±1.84^ab	<0.001
<10 mm	2.56±0.72	3.22±3.15	4.53±1.53^ab	<0.001
≥10 mm	2.50±1.60	2.83±1.03	5.38±2.31^ab	<0.001
术后并发症(n)	1	2	3	0.858
<10 mm	0	1	1	0.679
≥10 mm	1	1	2	1

项目	c-EMR组	m-EMR组	ESD组	P值
手术例数(n)	24	30	66
<10 mm	16	18	45
≥10 mm	8	12	21
成功切除率	22/24(91.7)	29/30(96.7)	64/66(97.0)	0.492
<10 mm	15/16(93.8)	18/18(100)	44/45(97.8)	0.416
≥10 mm	7/8(87.5 )	11/12(91.7)	20/21(95.2)	0.764
完整切除率	13/24(54.2)	26/30(86.7)^a	58/66(87.9)^a	0.001
<10 mm	11/16(68.8)	16/18(88.9)	40/45(88.9)	0.178
≥10 mm	2/8(25.0)	10/12(83.3)^a	18/21(85.7)^a	0.004
手术时间(min，±s)	14.92±1.53	15.2±2.11	26.56±4.29^ab	<0.001
<10 mm	15.5±0.89	15.17±2.12	26.22±4.55^ab	<0.001
≥10 mm	13.75±1.91	15.25±2.18	27.29±3.65^ab	<0.001
住院天数(d，±s)	2.54±1.06	3.07±2.50	4.08±1.84^ab	<0.001
<10 mm	2.56±0.72	3.22±3.15	4.53±1.53^ab	<0.001
≥10 mm	2.50±1.60	2.83±1.03	5.38±2.31^ab	<0.001
术后并发症(n)	1	2	3	0.858
<10 mm	0	1	1	0.679
≥10 mm	1	1	2	1

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