Endoscopic diagnosis and treatment of rectal neuroendocrine tumors and analysis of prognosis: report of 112 cases

Abstract

Objective To access the value of endoscopy in the diagnosis and treatment of rectal neuroendocrine tumors (NET). Methods A total of 112 rectal NET patients undergoing endoscopic resection in our hospital from 2011 to 2019 were enrolled in this retrospective study. Clinical manifestations, white light and endoscopic ultrasound (EUS) findings, endoscopic procedures, post-operative complications and pathological outcomes, follow-up data and prognosis were enrolled and analyzed. Results All of the 112 NETs were resected by endoscopy successfully. Among them, 8 NETs showed polypoid-like and the others appeared as submucosal tumor under white light. The results of EUS indicated that the origin of the tumors were mucosa (7, 7.5%), submucosa (67, 72.0%), mucosa and submucosa combined (17, 18.3%), and muscularis propria (2, 2.1%). During the endocopic dissection, muscularis propria damage occurred in 2 cases, and they were cured through clips and purse string suture. Delayed hemorrhage were observed in 4 cases, and were cured with endoscopic technique such as hot forceps. Pathological outcomes displayed that there were 106 cases of grade G1 and 6 cases of grade G2. Complete resection were achieved in 103 subjects, while 9 subjects had positive resection margins. All subjects were followed up till now, and only one of them experienced local relapse and underwent second endoscopic mucosal dissection. During the mean follow-up time of 49.4±25.3 months, all survived well. Conclusion Most of NET less than 1 cm in size are in grade G1. The tumor can be resected by endoscopy safely and effectively, and has favorable prognosis.

Keywords

• neuroendocrine tumors
• rectum
• endoscopic submucosal dissection
• endoscopic mucosal resection