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Oncological outcomes according to the treatment modality based on the size of rectal neuroendocrine tumors: a single-center retrospective study

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Abstract

Background

Owing to an increased number of colonoscopy screenings, the incidence of diagnosed rectal neuroendocrine tumors (NETs) has also increased. Tumor size is one of the most frequently regarded factors when selecting treatment; however, it may not be the determinant prognostic variable. We aimed to evaluate oncological outcomes according to the treatment modality based on the size of rectal NETs.

Methods

A retrospective analysis was performed on patients who were treated for rectal NETs between March 2000 and January 2016 at the Asan Medical Center, Seoul, Korea. Patients who underwent endoscopic removal, local surgical excision, and radical resection were included. The primary outcome was recurrence-free survival (RFS). Data were specified and analyzed following the 2019 World Health Organization classification (WHO).

Results

A total of 644 patients were categorized under three groups according to the treatment modality used: endoscopic removal (n = 567), surgical local excision (n = 56), and radical resection (n = 21). Of a total of 35 recurrences, 27 were local, whereas eight were distant. The RFS rate did not differ significantly between the treatment groups in the same tumor-size group (\(\le\)1 cm group: P = .636, 1–2 cm group: P = .160). For T1 tumors, RFS rate was not different between local excision and radical resection (\(\le\)1 cm group: P = .452, 1–2 cm group: P = .700). Depth of invasion, a high Ki-67 index, and margin involvement were confirmed as independent risk factors for recurrence. Among patients treated with endoscopic removal, endoscopic biopsy was a significant factor for worse RFS (P < .001), while tumor size did not affect the RFS.

Conclusion

The current guideline recommends treatment options according to tumor size. However, more oncologically important prognostic factors include muscularis propria invasion and a higher Ki-67 index.

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References

  1. Modlin IM, Lye KD, Kidd M (2003) A 5-decade analysis of 13,715 carcinoid tumors. Cancer 97(4):934–959

    Article  Google Scholar 

  2. Modlin IM et al (2008) Gastroenteropancreatic neuroendocrine tumours. Lancet Oncol 9(1):61–72

    Article  CAS  Google Scholar 

  3. Nam S et al (2020) Analysis of the incidence and clinical features of colorectal nonadenocarcinoma in Korea: A national cancer registry-based study. Ann Coloproctol 36(6):390–397

    Article  Google Scholar 

  4. Shah MH et al (2018) NCCN guidelines insights: neuroendocrine and adrenal tumors, version 2.2018. J Natl Compr Canc Netw 16(6):693–702

    Article  CAS  Google Scholar 

  5. Concors SJ et al (2018) Predictors of metastases in rectal neuroendocrine tumors: results of a national cohort study. Dis Colon Rectum 61(12):1372–1379

    Article  Google Scholar 

  6. Fine C et al (2019) Endoscopic management of 345 small rectal neuroendocrine tumours: a national study from the French group of endocrine tumours (GTE). United European Gastroenterol J 7(8):1102–1112

    Article  Google Scholar 

  7. Kim HR et al (2012) Transanal endoscopic microsurgery for the treatment of well-differentiated rectal neuroendocrine tumors. J Korean Soc Coloproctol 28(4):201–204

    Article  Google Scholar 

  8. Park CH et al (2011) Criteria for decision making after endoscopic resection of well-differentiated rectal carcinoids with regard to potential lymphatic spread. Endoscopy 43(9):790–795

    Article  CAS  Google Scholar 

  9. Takita M et al (2019) Clinical outcomes of patients with small rectal neuroendocrine tumors treated using endoscopic submucosal resection with a ligation device. Digestion 99(1):72–78

    Article  Google Scholar 

  10. McConnell YJ (2016) Surgical management of rectal carcinoids: trends and outcomes from the surveillance, epidemiology, and end results database (1988 to 2012). Am J Surg 211(5):877–885

    Article  Google Scholar 

  11. Shigeta K et al (2014) Long-term outcome of patients with locally resected high- and low-risk rectal carcinoid tumors. J Gastrointest Surg 18(4):768–773

    Article  Google Scholar 

  12. Kumar AS et al (2012) Transanal endoscopic microsurgery for rectal carcinoids: the largest reported United States experience. Colorectal Dis 14(5):562–566

    Article  CAS  Google Scholar 

  13. Kasuga A et al (2012) Treatment strategy for rectal carcinoids: a clinicopathological analysis of 229 cases at a single cancer institution. J Gastroenterol Hepatol 27(12):1801–1807

    Article  Google Scholar 

  14. Ngamruengphong S et al (2019) Prevalence of metastasis and survival of 788 patients with T1 rectal carcinoid tumors. Gastrointest Endosc 89(3):602–606

    Article  Google Scholar 

  15. Kim GU et al (2013) Clinical outcomes of rectal neuroendocrine tumors </= 10 mm following endoscopic resection. Endoscopy 45(12):1018–1023

    Article  Google Scholar 

  16. Chen WJ et al (2015) Full-thickness excision using transanal endoscopic microsurgery for treatment of rectal neuroendocrine tumors. World J Gastroenterol 21(30):9142–9149

    Article  Google Scholar 

  17. Arezzo A et al (2014) Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions. Surg Endosc 28(2):427–438

    Article  Google Scholar 

  18. Amin MB, Edge S, Greene F (2017) AJCC cancer staging manual. In: Edge S, Greene F, Amin MB (eds) ACC cancer staging manual. Springer, New York

    Chapter  Google Scholar 

  19. Nagtegaal ID et al (2020) The 2019 WHO classification of tumours of the digestive system. Histopathology 76(2):182–188

    Article  Google Scholar 

  20. de Mestier L et al (2013) Updating the management of patients with rectal neuroendocrine tumors. Endoscopy 45(12):1039–1046

    Article  Google Scholar 

  21. Al Natour RH et al (2012) Tumor size and depth predict rate of lymph node metastasis in colon carcinoids and can be used to select patients for endoscopic resection. J Gastrointest Surg 16(3):595–602

    Article  Google Scholar 

  22. Fujimoto Y et al (2010) Lymph-node metastases in rectal carcinoids. Langenbecks Arch Surg 395(2):139–142

    Article  Google Scholar 

  23. He L, Deng T, Luo H (2015) Efficacy and safety of endoscopic resection therapies for rectal carcinoid tumors: a meta-analysis. Yonsei Med J 56(1):72–81

    Article  Google Scholar 

  24. Gleeson FC et al (2014) Endoscopically identified well-differentiated rectal carcinoid tumors: impact of tumor size on the natural history and outcomes. Gastrointest Endosc 80(1):144–151

    Article  Google Scholar 

  25. Kulke MH (2015) Sequencing and combining systemic therapies for pancreatic neuroendocrine tumors. J Clin Oncol 33(14):1534–1538

    Article  Google Scholar 

  26. Kim JY, Hong SM (2016) Recent updates on neuroendocrine tumors from the gastrointestinal and pancreatobiliary tracts. Arch Pathol Lab Med 140(5):437–448

    Article  CAS  Google Scholar 

  27. Tsang ES et al (2018) Prognostic factors for locoregional recurrence in neuroendocrine tumors of the rectum. Dis Colon Rectum 61(2):187–192

    Article  Google Scholar 

  28. Choi CW et al (2017) The clinical outcomes and risk factors associated with incomplete endoscopic resection of rectal carcinoid tumor. Surg Endosc 31(12):5006–5011

    Article  Google Scholar 

  29. Moon CM et al (2016) Long-term clinical outcomes of rectal neuroendocrine tumors according to the pathologic status after initial endoscopic resection: a KASID multicenter study. Am J Gastroenterol 111(9):1276–1285

    Article  Google Scholar 

  30. Yan FH et al (2016) Endoscopic submucosal dissection versus transanal local excision for rectal carcinoid: a comparative study. World J Surg Oncol 14(1):162

    Article  Google Scholar 

  31. Kumar AS et al (2013) Complications of transanal endoscopic microsurgery are rare and minor: a single institution’s analysis and comparison to existing data. Dis Colon Rectum 56(3):295–300

    Article  Google Scholar 

  32. Sui Q et al (2017) Local surgical excision versus endoscopic resection for rectal carcinoid: a meta-analysis. J Cancer 8(19):3969–3974

    Article  Google Scholar 

  33. Wang X et al (2015) Endoscopic submucosal dissection for the treatment of rectal carcinoid tumors 7–16 mm in diameter. Int J Colorectal Dis 30(3):375–380

    Article  CAS  Google Scholar 

  34. Kwak MS et al (2018) Long-term outcome of small, incidentally detected rectal neuroendocrine tumors removed by simple excisional biopsy compared with the advanced endoscopic resection during screening colonoscopy. Dis Colon Rectum 61(3):338–346

    Article  Google Scholar 

  35. Kulke MH et al (2015) Neuroendocrine tumors version, 1.2015. J Natl Compr Canc Netw 13(1):78–108

    Article  CAS  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. In Ja Park and Dong-Hoon Yang are co-corresponding authors.

Authors and Affiliations

  1. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Jimin Son

  2. Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    In Ja Park, Young Il Kim, Jong Beom Kim, Seok-Byung Lim, Chang Sik Yu & Jin Cheon Kim

  3. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Dong-Hoon Yang, Kyoung-Jo Kim & Jeong-Sik Byeon

  4. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Jisup Kim & Seung Mo Hong

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  1. Jimin Son
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Correspondence to In Ja Park or Dong-Hoon Yang.

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Jimin Son, In Ja Park, Dong-Hoon Yang, Jisup Kim, Kyoung-Jo Kim, Jeong-Sik Byeon, Seung Mo Hong, Young Il Kim, Jong Beom Kim, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim have no conflicts of interest or financial ties to disclose.

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Son, J., Park, I.J., Yang, DH. et al. Oncological outcomes according to the treatment modality based on the size of rectal neuroendocrine tumors: a single-center retrospective study. Surg Endosc 36, 2445–2455 (2022). https://doi.org/10.1007/s00464-021-08527-6

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