1
|
Barnard P, Stephensen B, Taylor G, Huang J, de Jager E, McMahon M. Management & surveillance of rectal neuroendocrine tumours: a single-centre retrospective analysis. ANZ J Surg 2024; 94:1138-1145. [PMID: 38345172 DOI: 10.1111/ans.18895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND Rectal neuroendocrine tumours (rNETs) are rare but are increasing in incidence. Current management and surveillance recommendations are based on low-grade evidence. Follow-up practices are often inconsistent and costly. This retrospective study analyses a single-centre's experience with rNETs to assess incidence, management practices, outcomes, and guideline adherence. METHODS This is a single-centre retrospective study from Queensland Australia, spanning from 2012 to 2023. Twenty-eight rNET cases met inclusion criteria. Examined parameters included incidence, management, outcomes and adherence to European Neuroendocrine Tumour Society (ENETS) guidelines. R1 resection rate was analysed for associations with resection technique and lesion recognition and recurrence rate was assessed in all patients. RESULTS This study shows an increasing incidence of rNETs during the study period, reflecting a global trend. R1 resection rate at initial endoscopy was 75%. There was a general lack of advanced endoscopic techniques utilized and poor lesion recognition, however a statistically significant correlation was not established between these factors and an R1 result (P < 0.05). Most patients with an R1 result had subsequent re-resection to render the result R0, however five patients (33%) underwent surveillance with no reports of recurrence on follow-up. Overall, follow-up practices in our cohort were inconsistent and did not adhere to guidelines. CONCLUSION rNETs are increasing in incidence, emphasizing the need for standardized management and surveillance. Further training is required for rNET recognition and advanced endoscopic resection techniques. Further research is required to assess long-term outcomes in surveilled R1 cases, understand optimal endoscopic resection techniques and further develop local surveillance guidelines.
Collapse
Affiliation(s)
- Paige Barnard
- Department of Surgery and Critical Care, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Bree Stephensen
- Department of Surgery and Critical Care, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | | | - Johnson Huang
- Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Elzerie de Jager
- Division of Public Health, Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | | |
Collapse
|
2
|
Ge PS, Shi C, Asare E, Washington MK, O'Toole D. Expanding Role of Gastroenterology in the Staging of Digestive Neuroendocrine Tumors: Updates From the American Joint Committee on Cancer Version 9 Cancer Staging System. Clin Gastroenterol Hepatol 2024; 22:448-451. [PMID: 38056801 DOI: 10.1016/j.cgh.2023.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 12/08/2023]
Affiliation(s)
- Phillip S Ge
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center Houston, Texas
| | - Chanjuan Shi
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Elliot Asare
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Mary Kay Washington
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center Nashville, Tennessee
| | - Dermot O'Toole
- National Centre for Neuroendocrine Tumours, European Neuroendocrine Tumor Society (ENETS) Centre of Excellence, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
3
|
Hiyoshi Y, Daitoku N, Mukai T, Nagasaki T, Yamaguchi T, Akiyoshi T, Yasue C, Chino A, Saito S, Takamatsu M, Fukunaga Y. Risk Factors for Lymph Node Metastasis of Rectal Neuroendocrine Tumor and Its Prognostic Impact: A Single-Center Retrospective Analysis of 195 Cases with Radical Resection. Ann Surg Oncol 2023; 30:3944-3953. [PMID: 36935432 DOI: 10.1245/s10434-023-13348-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/16/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE The incidence of rectal neuroendocrine tumors (NETs) has been steadily increasing. The risk factors for and prognostic impact of lymph node (LN) metastasis were analyzed in 195 patients with stage I-III rectal NET who underwent radical surgery. METHODS This retrospective, single-center study analyzed risk factors for LN metastasis focusing on previously identified factors and a novel risk factor: multiple rectal NETs. The association between LN metastasis and the prognosis was also analyzed. RESULTS Pathologically, the LN metastasis rate (also the rate of stage III disease) was 39%, which was higher than the clinical LN metastasis rate of 14%. Tumor size > 10 mm, presence of central depression, tumor grade G2, depth of invasion, LN swelling on preoperative imaging (cN1), venous invasion and multiple NETs were identified as risk factors for LN metastasis. As the tumor size and risk factors increased, the rate of LN metastasis increased. Among these 7 factors, venous invasion, cN1, and multiple NETs were identified as independent predictors of LN metastasis. LN metastasis of rectal NETs was associated with significantly poor disease-free and disease-specific survival. CONCLUSIONS As risk factors increase, the potential for rectal NETs to metastasize to the LNs increases and LN metastasis is associated with a poor prognosis. This is the first study to report multiple NETs as a risk factor for LN metastasis. A future study examining the survival benefit of radical surgery accompanying LN dissection compared with local resection is warranted.
Collapse
Affiliation(s)
- Yukiharu Hiyoshi
- Gastroenterological Center, Department of Gastroenterological Surgery, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Nobuya Daitoku
- Gastroenterological Center, Department of Gastroenterological Surgery, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiki Mukai
- Gastroenterological Center, Department of Gastroenterological Surgery, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiya Nagasaki
- Gastroenterological Center, Department of Gastroenterological Surgery, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiro Yamaguchi
- Gastroenterological Center, Department of Gastroenterological Surgery, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Akiyoshi
- Gastroenterological Center, Department of Gastroenterological Surgery, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Chihiro Yasue
- Gastroenterological Center, Department of Lower Gastrointestinal Medicine, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiko Chino
- Gastroenterological Center, Department of Lower Gastrointestinal Medicine, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shoichi Saito
- Gastroenterological Center, Department of Lower Gastrointestinal Medicine, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Manabu Takamatsu
- Department of Pathology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Fukunaga
- Gastroenterological Center, Department of Gastroenterological Surgery, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| |
Collapse
|
4
|
Rinke A, Ambrosini V, Dromain C, Garcia-Carbonero R, Haji A, Koumarianou A, van Dijkum EN, O'Toole D, Rindi G, Scoazec JY, Ramage J. European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for colorectal neuroendocrine tumours. J Neuroendocrinol 2023; 35:e13309. [PMID: 37345509 DOI: 10.1111/jne.13309] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 06/23/2023]
Abstract
This ENETS guidance paper, developed by a multidisciplinary working group, provides an update on the previous colorectal guidance paper in a different format. Guided by key clinical questions practical advice on the diagnosis and management of neuroendocrine tumours (NET) of the caecum, colon, and rectum is provided. Although covered in one guidance paper colorectal NET comprises a heterogeneous group of neoplasms. The most common rectal NET are often small G1 tumours that can be treated by adequate endoscopic resection techniques. Evidence from prospective clinical trials on the treatment of metastatic colorectal NET is limited and discussion of patients in experienced multidisciplinary tumour boards strongly recommended. Neuroendocrine carcinomas (NEC) and mixed neuroendocrine non-neuroendocrine neoplasms (MiNEN) are discussed in a separate guidance paper.
Collapse
Affiliation(s)
- Anja Rinke
- Department of Gastroenterology, University Hospital Marburg and Philipps University Marburg, Marburg, Germany
| | - Valentina Ambrosini
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCSS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Clarisse Dromain
- Department of Radiology, CHUV Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Amyn Haji
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | - Anna Koumarianou
- Hematology Oncology Unit, Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Els Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC, Amsterdam, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Dermot O'Toole
- NET Center of Excellence, St Vincent's University Hospital and St James Hospital Dublin 8 and Trinity College Dublin, Dublin, Ireland
| | - Guido Rindi
- Section of Anatomic Pathology, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore; Unit of Head and Neck, Thoracic and Endcorine Pathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS; Roma European NeuroEndocrine Tumor Society (ENETS) Center of Excellence, Rome, Italy
| | - Jean-Yves Scoazec
- Department of Pathology, Gustave Roussy Cancer Campus, Villejuif, France, Université Paris Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, Villejuif, France
| | - John Ramage
- Department of Gastroenterology, Hampshire Hospitals and ENETS Center, Kings Health Partners London, London, UK
| |
Collapse
|
5
|
Matsuno K, Miyamoto H, Kitada H, Yoshimatsu S, Tamura F, Sakurai K, Fukubayashi K, Shono T, Setoyama H, Matsuyama T, Suko S, Narita R, Honda M, Tateyama M, Naoe H, Morinaga J, Tanaka Y, Gushima R. Comparison of endoscopic submucosal resection with ligation and endoscopic submucosal dissection for small rectal neuroendocrine tumors: A multicenter retrospective study. DEN OPEN 2023; 3:e163. [PMID: 36176350 PMCID: PMC9478042 DOI: 10.1002/deo2.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 11/23/2022]
Abstract
Objectives Endoscopic submucosal resection with band ligation (ESMR‐L) and endoscopic submucosal dissection (ESD) are both standard endoscopic resection methods for rectal neuroendocrine tumors (NETs) <10 mm in size. However, there is no definitive consensus on which is better. Here, we compared the efficacy of ESMR‐L and ESD for small rectal NETs. Methods This was a multicenter retrospective cohort study including 205 patients with rectal NETs who underwent ESMR‐L or ESD. Treatment outcomes were compared by univariate analysis, multivariate analysis, and inverse probability treatment weighting (IPTW) using propensity scores. Subgroup analysis evaluated the impact of the endoscopist's experience on the technical outcome. Results Eighty‐nine patients were treated by ESMR‐L and 116 by ESD. The R0 resection rate was not significantly different between the two (90% vs. 92%, p = 0.73). The procedure time of ESMR‐L was significantly shorter than for ESD (17 min vs. 52 min, p < 0.01) and the hospitalization period was also significantly shorter (3 days vs. 5 days, p < 0.01). These results were confirmed by multivariate analysis and also after IPTW adjustment. The procedure time of ESD was significantly prolonged by a less‐experienced endoscopist (49 min vs. 70 min, p = 0.02), but that of ESMR‐L was not affected (17 min vs. 17 min, p = 0.27). Conclusions For small rectal NETs, both ESMR‐L and ESD showed similar high complete resection rates. However, considering the shorter procedure time and shorter hospitalization period, ESMR‐L is the more efficient treatment method, especially for less‐experienced endoscopists.
Collapse
Affiliation(s)
- Kenshi Matsuno
- Department of Gastroenterology and Hepatology Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Hideaki Miyamoto
- Department of Gastroenterology and Hepatology Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Hideki Kitada
- Department of Gastroenterology Japanese Red Cross Kumamoto Hospital Kumamoto Japan
| | - Shinichi Yoshimatsu
- Department of Gastroenterology Kumamoto General Hospital Community Health Care Organization Kumamoto Japan
| | - Fumio Tamura
- Department of Gastroenterology Kumamoto Regional Medical Center Kumamoto Japan
| | | | | | - Takashi Shono
- Department of Gastroenterology Kumamoto Chuo Hospital Kumamoto Japan
| | - Hiroko Setoyama
- Department of Gastroenterology and Hepatology Faculty of Life Sciences Kumamoto University Kumamoto Japan
- Department of Gastroenterology Kumamoto Rosai Hospital Kumamoto Japan
| | - Taichi Matsuyama
- Department of Gastroenterology National Hospital Organization Kumamoto Medical Center Kumamoto Japan
| | - Shinichiro Suko
- Department of Gastroenterology Saiseikai Kumamoto Hospital Kumamoto Japan
| | - Rei Narita
- Department of Gastroenterology Minamata City Hospital and Medical Center Kumamoto Japan
| | - Munenori Honda
- Department of Gastroenterology and Hepatology Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Masakuni Tateyama
- Department of Gastroenterology and Hepatology Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Hideaki Naoe
- Department of Gastroenterology and Hepatology Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Jun Morinaga
- Department of Clinical Investigation (Biostatistics) Kumamoto University Hospital Kumamoto Japan
| | - Yasuhito Tanaka
- Department of Gastroenterology and Hepatology Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Ryosuke Gushima
- Department of Gastroenterology and Hepatology Faculty of Life Sciences Kumamoto University Kumamoto Japan
| |
Collapse
|
6
|
Ma XX, Wang LS, Wang LL, Long T, Xu ZL. Endoscopic treatment and management of rectal neuroendocrine tumors less than 10 mm in diameter. World J Gastrointest Endosc 2023; 15:19-31. [PMID: 36925647 PMCID: PMC10011890 DOI: 10.4253/wjge.v15.i2.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/19/2022] [Accepted: 02/01/2023] [Indexed: 02/13/2023] Open
Abstract
Rectal neuroendocrine tumors (rNETs) measuring less than 10 mm in diameter are defined as small rNETs. Due to the low risk of distant invasion and metastasis, endoscopic treatments, including modified endoscopic mucosal resection, endoscopic submucosal dissection, and other transanal surgical procedures, are effective. This review article proposes a follow-up plan according to the size and histopathology of the tumor after operation.
Collapse
Affiliation(s)
- Xiao-Xin Ma
- Department of Gastroenterology, Shenzhen People’s Hospital, the 2nd Clinical Medical College of Jinan University, Shenzhen 518000, Guangdong Province, China
| | - Li-Sheng Wang
- Department of Gastroenterology, Shenzhen People’s Hospital, the 2nd Clinical Medical College of Jinan University, Shenzhen 518000, Guangdong Province, China
| | - Luo-Lin Wang
- Department of Gastroenterology, Shenzhen People’s Hospital, the 2nd Clinical Medical College of Jinan University, Shenzhen 518000, Guangdong Province, China
| | - Ting Long
- Department of Pathology, Shenzhen People’s Hospital, the 2nd Clinical Medical College of Jinan University, Shenzhen 518000, Guangdong Province, China
| | - Zheng-Lei Xu
- Department of Gastroenterology, Shenzhen People’s Hospital, the 2nd Clinical Medical College of Jinan University, Shenzhen 518000, Guangdong Province, China
| |
Collapse
|
7
|
Multiple ligation-assisted endoscopic submucosal resection combined with endoscopic ultrasonography: a novel method to treat rectal neuroendocrine tumors. Eur J Gastroenterol Hepatol 2023; 35:174-180. [PMID: 36574308 DOI: 10.1097/meg.0000000000002486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The first choice of treatment for rectal neuroendocrine tumors (R-NETs) 10 mm in size is endoscopic resection, there is still controversy concerning the optimal endoscopic treatment for resecting R-NETs. This study evaluated the efficacy and safety of multiple ligation-assisted endoscopic submucosal resection combined with endoscopic ultrasonography (EMR-MLUS) for R-NETs. METHODS We retrospectively analyzed the data of 62 patients with R-NETs ≤10 mm in size who underwent EMR-MLUS or ligation-assisted endoscopic submucosal resection combined with endoscopic ultrasonography (EMR-LUS) between May 2019 and April 2022, including tumor characteristics, endoscopic complete resection, pathological complete resection, the procedure time, adverse events, and follow-up were compared between the two groups of patients. RESULTS Of the 62 patients, 19 underwent EMR-MLUS and 43 underwent EMR-LUS. The endoscopic morphology of lesions was statistically different between group EMR-MLUS and group EMR-LUS ( P = 0.015), and most of them were flat and slightly raised lesions in group EMR-MLUS. Although the pathological complete resection rate was slightly higher in the EMR-MLUS group than in the EMR-LUS group (94.74% vs. 90.70%; P = 0.290), the endoscopic complete resection rate was high in both groups. Involvement of the lateral resection margin was found four cases in the ESMR-LUS group; one case of deep resection margin involvement in the EMR-MLUS group. The mean procedure time was longer in the EMR-MLUS group than in the EMR-LUS group (12.79 ± 1.01 min vs. 11.08 ± 1.89 min; P = 0.041). In group EMR-LUS, there were two cases of immediate bleeding; in group EMR-MLUS, one case of perforation, all of them were successfully treated by endoscopy. No recurrence, progression, or metastasis was found in all patients. CONCLUSION EMR-MLUS is a safe and effective technique that could be considered when removing small rectal NETs, especially flat and slightly raised lesions.
Collapse
|
8
|
Liu W, Yuan XL, Hu B. Double ligation-assisted endoscopic submucosal resection for rectal neuroendocrine tumors. Endoscopy 2022; 54:E106-E107. [PMID: 33784753 DOI: 10.1055/a-1398-5378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Wei Liu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang-Lei Yuan
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
9
|
Cope J, Srirajaskanthan R. Rectal Neuroendocrine Neoplasms: Why Is There a Global Variation? Curr Oncol Rep 2022; 24:257-263. [PMID: 35084662 PMCID: PMC8885478 DOI: 10.1007/s11912-021-01172-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 12/13/2022]
Abstract
Purpose of Review This review examines the variation in incidence of rectal neuroendocrine tumours across the globe. Rectal neuroendocrine tumours are a common type of gastrointestinal NET with an increasing incidence reported over the last 30 years. Recent Findings There have been a number of publications examining the epidemiology of neuroendocrine tumours across the world. These have utilized a variety of different methodologies to examine both incidence of prevalence of NETs. We review the data published and describe any causative factors and findings regarding the epidemiology of rectal NETs. Summary Rectal NETs account for 1–2% of all rectal cancers and are commonly diagnosed between 50–60 years of age. Most lesions are identified by chance at colonoscopy, commonly during colon cancer screening procedures, which is reflected in part in the age at diagnosis. Most lesions are small in size, < 10 mm and can be managed with endoscopic resection rather than requiring surgery. The highest incidence is reported in people of Asian ethnicity, with a tenfold increased incidence reported in some series compared with white population. There is also an increased incidence in Black and Hispanic population as identified through the Surveillance, Epidemiology and End Results (SEER) database. Endoscopic assessment of lesions is variable globally. Future work to better understand the cause of ethnic variation and development of comprehensive cancer registries would be helpful.
Collapse
Affiliation(s)
- Jack Cope
- Department of Gastroenterology, Kings College Hospital, London, SE5 9RS, UK
| | - Raj Srirajaskanthan
- Department of Gastroenterology, Kings College Hospital, London, SE5 9RS, UK. .,Kings Health Partners ENETs Centre of Excellence Neuroendocrine Tumour Unit, Institute of Liver Studies, Kings College Hospital, London, SE5 9RS, UK.
| |
Collapse
|