Kazuhiko Nakamura1, Mikako Osada2, Ayako Goto1, Tsutomu Iwasa1, Shunsuke Takahashi2, Nobuyoshi Takizawa2, Kazuya Akahoshi3, Toshiaki Ochiai4, Norimoto Nakamura5, Hirotada Akiho6, Soichi Itaba7, Naohiko Harada8, Moritomo Iju9, Munehiro Tanaka10, Hiroaki Kubo11, Shinichi Somada12, Eikichi Ihara1, Yoshinao Oda2, Tetsuhide Ito1, Ryoichi Takayanagi1. 1. a Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan ; 2. b Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan ; 3. c Department of Gastroenterology , Aso Iizuka Hospital , Iizuka , Japan ; 4. d Department of Internal Medicine , Saiseikai Fukuoka General Hospital , Fukuoka , Japan ; 5. e Department of Gastroenterology , Harasanshin Hospital , Hakata-Ku , Fukuoka , Japan ; 6. f Department of Gastroenterology , Kitakyushu Municipal Medical Center , Kokurakita-Ku , Kitakyushu , Japan ; 7. g Department of Gastroenterology , Kyushu Rosai Hospital , Kitakyushu, Fukuoka , Japan ; 8. h Department of Gastroenterology , National Hospital Organization Kyushu Medical Center , Chuo-Ku , Fukuoka , Japan ; 9. i Department of Gastroenterology , Fukuoka City Hospital , Hakata-Ku , Fukuoka , Japan ; 10. j Department of Gastroenterology and Hepatology , National Hospital Organization Fukuoka Higashi Medical Center , Koga , Japan ; 11. k Department of Internal Medicine , Social Insurance Nakabaru Hospital , Shime-Machi , Kasuya-Gun , Japan ; 12. l Department of Gastroenterology , National Hospital Organization Beppu Medical Center , Beppu , Oita Japan.
Abstract
OBJECTIVE: Although the World Health Organisation (WHO) defined a novel classification of gastroenteropancreatic neuroendocrine tumours (NETs) in 2010, indications for endoscopic resection of rectal NETs in the guidelines were based on evidence accumulated for carcinoid tumours defined by a previous classification. This study was designed to clarify indications for endoscopic resection of rectal NETs corresponding to the new WHO classifications. MATERIAL AND METHODS: One hundred-seventy rectal NETs resected endoscopically from April 2001 to March 2012 were histologically re-classified according to the WHO 2010 criteria. The clinicopathological features of these lesions were analysed, and the short- and long-term outcomes of endoscopic resection were evaluated. RESULTS: Of the 170 rectal NETs, 166 were histopathologically diagnosed as NET G1 and four as NET G2. Thirty-eight tumours (22.4%) were positive for lymphovascular invasion, a percentage higher than expected. Although the curative resection rate was low (65.3%), en bloc (98.8%) and complete (85.9%) resection rates were high. Modified endoscopic mucosal resection (88.0%) and endoscopic submucosal dissection (92.2%) resulted in significantly higher complete resection rates than conventional endoscopic mucosal resection (36.4%). No patient experienced tumour recurrence, despite the low curative resection rate. CONCLUSION: Despite the low curative resection rate, prognosis after endoscopic resection of rectal NETs was excellent. Prospective large-scale, long-term studies are required to determine whether NET G2 and tumours >1 cm should be included in the indication for endoscopic resection and whether tumours with lymphovascular invasion can be followed up without additional surgery.
OBJECTIVE: Although the World Health Organisation (WHO) defined a novel classification of gastroenteropancreatic neuroendocrine tumours (NETs) in 2010, indications for endoscopic resection of rectal NETs in the guidelines were based on evidence accumulated for carcinoid tumours defined by a previous classification. This study was designed to clarify indications for endoscopic resection of rectal NETs corresponding to the new WHO classifications. MATERIAL AND METHODS: One hundred-seventy rectal NETs resected endoscopically from April 2001 to March 2012 were histologically re-classified according to the WHO 2010 criteria. The clinicopathological features of these lesions were analysed, and the short- and long-term outcomes of endoscopic resection were evaluated. RESULTS: Of the 170 rectal NETs, 166 were histopathologically diagnosed as NET G1 and four as NET G2. Thirty-eight tumours (22.4%) were positive for lymphovascular invasion, a percentage higher than expected. Although the curative resection rate was low (65.3%), en bloc (98.8%) and complete (85.9%) resection rates were high. Modified endoscopic mucosal resection (88.0%) and endoscopic submucosal dissection (92.2%) resulted in significantly higher complete resection rates than conventional endoscopic mucosal resection (36.4%). No patient experienced tumour recurrence, despite the low curative resection rate. CONCLUSION: Despite the low curative resection rate, prognosis after endoscopic resection of rectal NETs was excellent. Prospective large-scale, long-term studies are required to determine whether NET G2 and tumours >1 cm should be included in the indication for endoscopic resection and whether tumours with lymphovascular invasion can be followed up without additional surgery.
Authors: Caroline Fine; Guillaume Roquin; Eric Terrebonne; Thierry Lecomte; Romain Coriat; Christine Do Cao; Louis de Mestier; Elise Coffin; Guillaume Cadiot; Patricia Nicolli; Vincent Lepiliez; Vincent Hautefeuille; Jeanne Ramos; Paul Girot; Sophie Dominguez; Fritz-Line V Céphise; Julien Forestier; Valérie Hervieu; Mathieu Pioche; Thomas Walter Journal: United European Gastroenterol J Date: 2019-07-04 Impact factor: 4.623
Authors: Jin Lee; Yong Eun Park; Joon Hyuk Choi; Nae-Yun Heo; Jongha Park; Seung Ha Park; Young Soo Moon; Kyung Han Nam; Tae Oh Kim Journal: Ann Gastroenterol Date: 2020-05-10