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Zhang Y, Yang Y, Gao C, Zhao H, Zhou H. Lateral pelvic lymph nodes dissection of rectal neuroendocrine neoplasms: A prospective case-series and literature review. Surgery 2024; 176:1360-1365. [PMID: 39147667 DOI: 10.1016/j.surg.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Rectal neuroendocrine neoplasms are relatively rare. Patients with rectal neuroendocrine neoplasms undergoing radical surgery have a higher rate of lymph node metastases. Robust evidence on the status of lateral pelvic lymph node metastases and the role of lateral pelvic lymph node dissection in those patients is lacking. This case-series study aimed to explore and address these issues. METHODS This single-center, prospective case series consecutively enrolled patients with biopsy-proven rectal neuroendocrine neoplasms in a tertiary referral hospital between June 2022 and January 2024. All eligible patients underwent laparoscopic total mesorectal excision surgery and bilateral lateral pelvic lymph node dissection under general anesthesia. The clinicopathologic features, surgical outcomes, and postoperative complications were presented. The last follow-up was conducted in March 2024. RESULTS A total of 11 patients with rectal neuroendocrine neoplasms-3 female and 8 male-were enrolled. The average age was 60.0 years (range, 53.5-65.5 years), and the median tumor size was 2.0 cm (range, 1.6-2.5 cm). Tumors invaded the muscularis propria in 7 patients. There were 3 cases of neuroendocrine tumor G1, 6 cases of neuroendocrine tumor G2, and 2 cases of neuroendocrine carcinoma. Among these patients, 11 (100.0%) had lymph node metastases, and 6 (54.5%) had lateral pelvic lymph node metastases. In addition, in 2 patients, only lateral pelvic lymph node metastases were observed, without involvement of the mesenteric lymph nodes. Five patients had tumors located on the left wall of the rectum, and only left-sided lateral pelvic lymph node metastases were observed. The other patient had both sides of lateral pelvic lymph node metastases due to circumferential growth of the tumor around the rectum. Anal preservation was achieved in all patients. The median operating time was 235.0 minutes (range, 210.5-335.5 minutes), and the median estimated blood loss was 50.0 mL (range, 45.0-75.0 mL). Two patients experienced postoperative dysuria and recovered spontaneously within 2-4 months after surgery. CONCLUSION On the basis of a prospective case series, we demonstrate, for the first time, the lateral pelvic lymph node metastasis status in patients with rectal neuroendocrine neoplasms requiring radical total mesorectal excision surgery. Simultaneous bilateral lateral pelvic lymph node dissection may be a feasible and beneficial procedure for preventing local recurrence in these patients due to the lack of definitive neoadjuvant or adjuvant therapy options.
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Affiliation(s)
- Yueyang Zhang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Yi Yang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Changyuan Gao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Hong Zhao
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Haitao Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China.
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Choi JS, Kim MJ, Shin R, Park JW, Heo SC, Jeong SY, Park KJ, Ryoo SB. Risk Factor Analysis of Lymph Node Metastasis for Rectal Neuroendocrine Tumors: Who Needs a Radical Resection in Rectal Neuroendocrine Tumors Sized 1-2 cm? Ann Surg Oncol 2024; 31:2414-2424. [PMID: 38194045 DOI: 10.1245/s10434-023-14829-x] [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: 06/01/2023] [Accepted: 12/08/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Rectal neuroendocrine tumors (NETs) have malignant potential, and lymph node (LN) or distant metastases can occur; however, treatment of NETs 1-2 cm in size is controversial. OBJECTIVE This study aimed to identify predictive factors for LN metastasis and prognostic factors for recurrence of rectal NETs, especially tumors 1‒2 cm in size. METHODS Between October 2004 and November 2020, 453 patients underwent endoscopic or surgical treatment for rectal NETs in Seoul National University Hospital. The data on these patients were prospectively collected in our database and reviewed retrospectively. In cases of local excision, we evaluated LN metastasis with radiologic imaging, including computed tomography or magnetic resonance imaging before treatment and during the follow-up periods. RESULTS LN metastasis was observed in 40 patients (8.8%). A higher rate of LN metastasis was observed in larger-sized tumors, advanced T stage, lymphovascular invasion (LVI), perineural invasion (PNI), and high tumor grade. In multivariable analysis, the significant risk factors for LN metastasis were tumor size (1 ≤ size < 2 cm: hazard ratio [HR] 64.07; size ≥2 cm: HR 102.37, p < 0.001) and tumor grade (G2: HR 3.63, p = 0.034; G3: HR 5.09, p = 0.044). In multivariable analysis for tumors 1-2 cm in size, the risk factor for LN metastasis was tumor grade (G2: HR 6.34, p = 0.013). CONCLUSIONS Tumor grade and size are important predictive factors for LN metastasis. In NETs 2 cm in size, tumor grade is also important for LN metastasis, and radical resection should be considered.
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Affiliation(s)
- Jin Sun Choi
- Department of Surgery, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min Jung Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Surgery, Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Rumi Shin
- Department of Surgery, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Ji Won Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Surgery, Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Seung Chul Heo
- Department of Surgery, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Seung-Yong Jeong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Surgery, Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Surgery, Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Seung-Bum Ryoo
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Surgery, Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.
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Kang HS, Park HY, Lim H, Son IT, Kim MJ, Kim NY, Kim MJ, Nam ES, Cho SJ, Kwon MJ. Different miRNAs Related to FBXW7 Mutations or High Mitotic Indices Contribute to Rectal Neuroendocrine Tumors: A Pilot Study. Int J Mol Sci 2023; 24:ijms24076329. [PMID: 37047300 PMCID: PMC10093831 DOI: 10.3390/ijms24076329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Recent studies suggest that miRNA may be involved in the development of rectal neuroendocrine tumors (NETs). We explored the frequency of clinicopathologically relevant mutations and miRNA expression in rectal NETs to examine molecular profiles related to prognosis and behavior. Twenty-four eligible specimens with endoscopically excised rectal NETs were selected. Next-generation sequencing and an miRNA expression assay were used to evaluate the expression profile relevant to common genetic mutations in rectal NETs. Kyoto Encyclopedia of Genes and Genomes analysis predicted that the possible target signaling pathways were correlated with dysregulated miRNAs. Nineteen rectal NETs harbored more than one mutation in the 24 cancer-related genes. Seven miRNAs (hsa-miR-769-5p, hsa-miR-221-3p, hsa-miR-34a-5p, hsa-miR-181c-5p, hsa-miR-1246, hsa-miR-324-5p, and hsa-miR-361-3p) were significantly down-regulated in tumors harboring the FBWX7 mutation. Unsupervised hierarchical clustering analysis showed that up-regulation of these seven miRNAs may result in high mitotic indices, indicating the role of miRNAs in tumor progression. Among the down-regulated miRNAs, hsa-miR-769-5p was strongly correlated with extracellular matrix–receptor interaction and lysine degradation. Among the clinicopathological factors, up-regulated hsa-miR-3934-5p was linked to an increased mitotic count. No change in miRNA expression was associated with a tumor size >1 cm, lymphovascular invasion, or Ki-67 index. In summary, we identified different miRNA signatures involved in FBXW7 mutations or high mitotic indices in rectal NETs, which may play a critical role in tumor behavior.
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Affiliation(s)
- Ho Suk Kang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Ha Young Park
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan 47392, Republic of Korea
| | - Hyun Lim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Il Tae Son
- Department of Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Min-Jeong Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Nan Young Kim
- Hallym Institute of Translational Genomics and Bioinformatics, Hallym University Medical Center, Anyang 14068, Republic of Korea
| | - Min Jeong Kim
- Department of Surgery, Kangdong Sacred Heart Hospital, Seoul 05355, Republic of Korea
| | - Eun Sook Nam
- Department of Pathology, Kangdong Sacred Heart Hospital, Seoul 05355, Republic of Korea
| | - Seong Jin Cho
- Department of Pathology, Kangdong Sacred Heart Hospital, Seoul 05355, Republic of Korea
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
- Correspondence:
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Zheng Y, Guo K, Zeng R, Chen Z, Liu W, Zhang X, Liang W, Liu J, Chen H, Sha W. Prognosis of rectal neuroendocrine tumors after endoscopic resection: a single-center retrospective study. J Gastrointest Oncol 2021; 12:2763-2774. [PMID: 35070405 PMCID: PMC8748065 DOI: 10.21037/jgo-21-391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/24/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The efficacy of endoscopic resection in patients with rectal neuroendocrine tumors (NETs) which are less than 20 mm in diameter remains unclear. This study aimed to investigate the efficacy and outcomes of different types of endoscopic resection in patients with NETs. METHODS We performed a retrospective analysis and follow-up on 98 patients who underwent endoscopic resection for rectal NETs between August 2010 and October 2019 at Guangdong Provincial People's Hospital, China. The lesions were preoperatively classified according to their endoscopic morphology and measured by endoscopic ultrasound. Patients were divided into modified endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) groups depending on the endoscopic treatment they received. The en bloc resection rate, histopathological complete resection rate, and the complication rate of the 2 groups were evaluated after the operation. The risk factors for incomplete resection were also analyzed. RESULTS The average diameter of the 98 NETs was 6.29±2.90 mm (range, 2-15 mm). The en bloc resection rate of the modified EMR and ESD treatment groups was 97.2% (35/36) and 100% (62/62), respectively. The histopathological complete resection rate was 86.1% (31/36) and 87.1% (54/62), respectively. No tumor recurrence or tumor-related death occurred. There were no statistically significant differences in the rate of histopathological complete resection, perforation, or delayed hemorrhage between the 2 groups (P>0.05). Multivariate analysis demonstrated that the depth of tumor invasion (P=0.007) and tumor diameter (P<0.001) were independent risk factors for histopathological complete resection. CONCLUSIONS Modified EMR and ESD are safe and effective endoscopic approaches for the resection of rectal NETs ≤15 mm in diameter. Endoscopic resection requires a comprehensive preoperative evaluation of risk factors including the depth of tumor invasion and tumor diameter.
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Affiliation(s)
- Yue Zheng
- Department of Gastroenterology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kehang Guo
- Department of Gastroenterology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Ruijie Zeng
- Department of Gastroenterology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Zhendao Chen
- Department of Gastroenterology, Huazhou People’s Hospital, Maoming, China
| | - Wanwei Liu
- Department of Gastroenterology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaoguang Zhang
- Department of Gastroenterology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weimin Liang
- Department of Gastroenterology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jianhua Liu
- Department of Oncology, Cancer Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hao Chen
- Department of Gastroenterology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weihong Sha
- Department of Gastroenterology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Chen Q, Chen J, Huang Z, Zhao H, Cai J. Comparable survival benefit of local excision versus radical resection for 10- to 20-mm rectal neuroendocrine tumors. Eur J Surg Oncol 2021; 48:864-872. [PMID: 34753616 DOI: 10.1016/j.ejso.2021.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The optimal surgical management for 10- to 20-mm rectal neuroendocrine tumors (RNET) is still a matter of debate. This study aimed to explore the optimal surgical approach for 10- to 20-mm RNET by comparing the outcomes between local excision and radical resection. METHOD We extracted clinicopathological information of 10- to 20-mm RNET from the Surveillance, Epidemiology, and End Results (SEER) database. The 1:2 propensity score matching (PSM) method was used to balance the imbalanced baseline covariates (P < 0.05) between the local excision group and radical resection group. A Cox proportional hazards model was used to identify the risk factors associated with cancer-specific survival (CSS) and overall survival (OS). RESULT A total of 531 RNET patients 10-20 mm in size were included. Patients receiving radical resection had larger tumor sizes (P < 0.001), higher T stages (P < 0.001), higher N stages (P < 0.001), higher M stages (P = 0.002) and higher grades (P = 0.041). For 10-20 mm RNET patients, radical resection had no survival benefit compared with local excision (CSS: HR = 2.048, 95% CI 0.553-7.576, P = 0.283; OS: HR = 1.090, 95% CI 0.535-2.219, P = 0.813). After 1:2 PSM, there was no significant difference between local excision and radical resection. Radical resection still had no survival benefit over local excision (CSS: HR = 0.449, 95% CI 0.050-4.022, P = 0.474; OS: HR = 1.408, 95% CI 0.488-4.061, P = 0.527). In a multivariate analysis of CSS, age >60 years old (P = 0.005), tumour size 14-20 mm (P = 0.011) and M1 stage (P < 0.001) were identified as independent prognostic factors for worse CSS. In multivariate analysis of OS, age>60 years (P<0.001), male sex (P = 0.007), black race (P = 0.016), and T2/T3/T4 stage (P = 0.007) were significantly associated with worse OS. N stage was not an independent predictive factor for CSS and OS. CONCLUSION This study revealed that for 10- to 20-mm RNET patients, there was no survival benefit for radical resection compared with local excision, which suggested that local excision may be an adequate treatment for these patients.
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Affiliation(s)
- Qichen Chen
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Jinghua Chen
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Zhen Huang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Hong Zhao
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China.
| | - Jianqiang Cai
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China.
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6
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Nam SJ, Kim BC, Chang HJ, Jeon HH, Kim J, Kim SY. Risk Factors for Lymph Node Metastasis and Oncologic Outcomes in Small Rectal Neuroendocrine Tumors with Lymphovascular Invasion. Gut Liver 2021; 16:228-235. [PMID: 34552040 PMCID: PMC8924811 DOI: 10.5009/gnl20364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/31/2021] [Accepted: 04/20/2021] [Indexed: 11/08/2022] Open
Abstract
Background/Aims Small rectal neuroendocrine tumors (NETs) are often managed with local resection (endoscopic or transanal excision) owing to their low risk of metastasis and recurrence. However, the clinical significance of lymphovascular invasion in resected specimens remains controversial. In this study, we aimed to analyze the frequency of and risk factors for lymph node metastasis proven by histopathologic examination after radical resection. Methods We retrospectively reviewed the records of 750 patients diagnosed with a rectal NET at four academic medical centers in South Korea between 2001 and 2019. The frequency of histopathologically proven lymph node metastasis and the associated risk factors were analyzed for small tumors (≤1.5 cm) with lymphovascular invasion. Results Among 750 patients, 75 had a small tumor (≤1.5 cm) with lymphovascular invasion, of whom 31 patients underwent endoscopic resection only and 44 patients underwent additional radical surgery. Among the 41 patients who underwent surgery and had available data, the rate of regional lymph node metastasis was 48.8% (20/41). In multivariate analysis, the Ki-67 index (odds ratio, 6.279; 95% confidence interval, 1.212 to 32.528; p=0.029) was an independent risk factor for lymph node metastasis. During the mean follow-up period of 37.7 months, only one case of recurrence was detected in the surgery group. The overall survival was not significantly different between radical resection and local resection (p=0.332). Conclusions Rectal NETs with lymphovascular invasion showed a significantly high rate of regional lymph node metastasis despite their small size (≤1.5 cm).
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Affiliation(s)
- Seung-Joo Nam
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Byung Chang Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hee Jin Chang
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.,Department of Pathology, Research Institute and Hospital, National Cancer Center, Goyang, Korea.,Precision Medicine, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Han Ho Jeon
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Junho Kim
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Su Young Kim
- Divison of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Alnimri F, Ng MW, Modak P. Rectal carcinoid tumour presenting as polyp: a challenge in management in rural settings. ANZ J Surg 2021; 91:1318-1319. [PMID: 34121291 DOI: 10.1111/ans.16857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/28/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Feras Alnimri
- General Surgery Unit, Swan Hill District Health, Swan Hill, Victoria, Australia.,Department of Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Michelle W Ng
- General Surgery Unit, Swan Hill District Health, Swan Hill, Victoria, Australia.,Department of Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Prasenjit Modak
- General Surgery Unit, Swan Hill District Health, Swan Hill, Victoria, Australia
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Yumoto S, Miyamoto Y, Akiyama T, Kiyozumi Y, Eto K, Hiyoshi Y, Nagai Y, Iwatsuki M, Baba Y, Iwagami S, Yoshida N, Baba H. Synchronous NET and colorectal cancer development: a case report. Surg Case Rep 2020; 6:10. [PMID: 31919616 PMCID: PMC6952479 DOI: 10.1186/s40792-020-0777-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/31/2019] [Indexed: 12/05/2022] Open
Abstract
Background The incidence of synchronous gastrointestinal neuroendocrine tumors (GI-NETs) and colorectal cancer is very low. Case presentation We present a 72-year-old man diagnosed with a rectal neuroendocrine tumor (NET) with multiple organ metastases and simultaneous sigmoid colon cancer. Although the NET was his prognostic factor, he underwent a laparoscopic sigmoidectomy at first because it was expected that the colon cancer would cause obstruction or bleeding during NET treatment. Subsequently, he started taking everolimus. Conclusions We should consider surgical resection of the synchronous cancer before systemic therapy for a GI-NET regardless of the difference in prognosis between synchronous tumors, if the cancer may impair the continuation of systemic therapy.
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Affiliation(s)
- Shinsei Yumoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takahiko Akiyama
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yuki Kiyozumi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kojiro Eto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yukiharu Hiyoshi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yohei Nagai
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Shiro Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
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9
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de Mestier L, Lorenzo D, Fine C, Cros J, Hentic O, Walter T, Panis Y, Couvelard A, Cadiot G, Ruszniewski P. Endoscopic, transanal, laparoscopic, and transabdominal management of rectal neuroendocrine tumors. Best Pract Res Clin Endocrinol Metab 2019; 33:101293. [PMID: 31326374 DOI: 10.1016/j.beem.2019.101293] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rectal neuroendocrine tumors (RNET) are rare tumors but their prevalence is constantly increasing due to a prolonged survival and rising incidence related to a growing number of colonoscopies and improved knowledge. Their main prognostic determinant is tumor stage. While most RNET are localized, their management should be tailored depending on the presence or absence of the factors predictive of lymph-node metastases including tumor size, endoscopic aspect, T stage, grade and lymphovascular invasion. Endoscopic ultrasonography is the most relevant technique for locoregional assessment. Low-risk RNET can be treated using advanced endoscopic resection techniques or transanal endoscopic microsurgery, in expert centers because they require technicity and experience. Conversely, radical surgery with lymphadenectomy should be proposed in the presence of any pejorative factor. The long-term evolution of RNET remains to be specified, and prospective studies should be conducted in order to determine the relevance of the current management strategies.
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Affiliation(s)
- Louis de Mestier
- Department of Pancreatology and Gastroenterology, ENETS Centre of Excellence, AP-HP, Beaujon Hospital, Clichy, France; Université de Paris, France; INSERM UMR1149, Paris, France.
| | - Diane Lorenzo
- Department of Pancreatology and Gastroenterology, ENETS Centre of Excellence, AP-HP, Beaujon Hospital, Clichy, France; Université de Paris, France
| | - Caroline Fine
- Department of Digestive Oncology, ENETS Centre of Excellence, Edouard Herriot University Hospital, Lyon, France
| | - Jérôme Cros
- Université de Paris, France; INSERM UMR1149, Paris, France; Department of Pathology, ENETS Centre of Excellence, AP-HP, Bichat/Beaujon Hospital, Clichy, France
| | - Olivia Hentic
- Department of Pancreatology and Gastroenterology, ENETS Centre of Excellence, AP-HP, Beaujon Hospital, Clichy, France
| | - Thomas Walter
- Department of Digestive Oncology, ENETS Centre of Excellence, Edouard Herriot University Hospital, Lyon, France
| | - Yves Panis
- Université de Paris, France; Department of Colorectal Surgery, ENETS Centre of Excellence, AP-HP, Beaujon Hospital, Clichy, France
| | - Anne Couvelard
- Université de Paris, France; INSERM UMR1149, Paris, France; Department of Pathology, ENETS Centre of Excellence, AP-HP, Bichat/Beaujon Hospital, Clichy, France
| | - Guillaume Cadiot
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert Debré Hospital and Reims-Champagne-Ardennes University, Reims, France
| | - Philippe Ruszniewski
- Department of Pancreatology and Gastroenterology, ENETS Centre of Excellence, AP-HP, Beaujon Hospital, Clichy, France; Université de Paris, France; INSERM UMR1149, Paris, France
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10
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Kang HS, Kwon MJ, Kim TH, Han J, Ju YS. Lymphovascular invasion as a prognostic value in small rectal neuroendocrine tumor treated by local excision: A systematic review and meta-analysis. Pathol Res Pract 2019; 215:152642. [PMID: 31585816 DOI: 10.1016/j.prp.2019.152642] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 08/26/2019] [Accepted: 09/15/2019] [Indexed: 02/07/2023]
Abstract
Because rectal neuroendocrine tumors (NETs) are usually small-sized despite of malignant potential, endoscopic resection techniques are recommended. It is unclear whether the lymphovascular invasion (LVI) in the endoscopic resected specimens of small rectal NETs should be indicated for completion surgery. We performed a systematic review and meta-analysis for the incidence of LVI in small rectal NETs (≤20 mm) treated by endoscopic resection and its prognostic impacts. We searched the relevant literature published before January 2019. A total of 21 publications including 1816 patients were enrolled. Overall prevalence of LVI in small rectal NETs was 21.8%. Immunohistochemical method significantly increased the detection rate of LVI up to 35.8% compared than H&E staining only (13.2%). Tumor size more than 5 mm was a risk factor for LVI in small rectal NET, whereas tumor grade did not influence the risk. The LVI in the endoscopic resected specimens was a risk factor for subsequent lymph node metastasis. Separately analyzed in detail, the vascular invasion had a stronger impact on lymph node metastasis than the lymphatic invasion. The prognosis of endoscopically treated rectal NET with LVI was excellent with only 0.3% of recurrence rate during the 5-year follow-up period. LVI is highly prevalent and a risk factor for lymph node metastasis in the small rectal NETs. Endoscopically treated small rectal NETs had excellent short-term prognoses despite of LVI. Immediate completion radical surgery is not absolutely necessary for the LVI-positive small rectal NETs. However, long-term follow-up is recommended for any delayed recurrence.
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Affiliation(s)
- Ho Suk Kang
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Gyeonggi-do, Republic of Korea
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Gyeonggi-do, Republic of Korea.
| | - Tae-Hwan Kim
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Gyeonggi-do, Republic of Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon, Republic of Korea
| | - Young-Su Ju
- Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Republic of Korea
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Ngamruengphong S, Kamal A, Akshintala V, Hajiyeva G, Hanada Y, Chen YI, Sanaei O, Fluxa D, Haito Chavez Y, Kumbhari V, Singh VK, Lennon AM, Canto MI, Khashab MA. Prevalence of metastasis and survival of 788 patients with T1 rectal carcinoid tumors. Gastrointest Endosc 2019; 89:602-606. [PMID: 30447216 DOI: 10.1016/j.gie.2018.11.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 11/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Prevalence of rectal carcinoids is increasing, partly because of increased colorectal cancer screening. Local excision (endoscopic or transanal excision) is usually performed for small (<1-2 cm) rectal carcinoids, but data on clinical outcomes from large population-based U.S. studies are lacking. The aims of this study were to determine the prevalence of metastasis of resected small rectal carcinoid tumors using a large national cancer database and to evaluate the long-term survival of patients after local resection as compared with radical surgery. METHODS The Surveillance Epidemiology and End Results database was used to identify 788 patients with rectal T1 carcinoids <2 cm in size. Prevalence of metastases at initial diagnosis and risk factors for metastases were analyzed. Cancer-specific survival (CSS) was calculated. RESULTS A total of 727 patients (92.3%) had tumors ≤10 mm in diameter and 61 (7.7%) had tumors 11 to 19 mm. Overall, 12 patients (1.5%) had metastasis at the time of diagnosis with prevalence of 1.1% in lesions ≤10 mm and 6.6% in lesions 11 to 19 mm (P = .01). Survival of patients with T1 rectal carcinoids without metastasis was significantly better than those with metastasis (5-year CSS of 100% vs 78%, P < .001). Of 559 patients with T1N0M0 rectal carcinoids ≤10 mm, 5-year CSS was 100% in both groups who underwent local excision and those who underwent radical surgery. CONCLUSIONS Larger T1 rectal carcinoid tumors (11-19 mm) have significantly higher risk of lymph node metastases compared with those ≤10 mm. Survival is worse with metastatic disease. Local therapy is adequate for T1N0M0 rectal carcinoids ≤10 mm in size with excellent long-term outcomes.
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Affiliation(s)
| | - Ayesha Kamal
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Venkata Akshintala
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Gulara Hajiyeva
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Yuri Hanada
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Yen-I Chen
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Omid Sanaei
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Daniela Fluxa
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Yamile Haito Chavez
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Vivek Kumbhari
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Vikesh K Singh
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Anne Marie Lennon
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Marcia Irene Canto
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Mouen A Khashab
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Nam SJ, Chae GB, Lee S, Park SC, Kang CD, Lee SJ. A small, well-differentiated rectal neuroendocrine tumor with multiple lymph node metastases: A case report. Oncol Lett 2018; 15:7139-7143. [PMID: 29725436 PMCID: PMC5920250 DOI: 10.3892/ol.2018.8257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 01/29/2018] [Indexed: 11/05/2022] Open
Abstract
The incidence of rectal neuroendocrine tumor (NET), which is often diagnosed during routine surveillance endoscopy, is increasing. The majority of these tumors are small and asymptomatic, possessing benign features with favorable prognoses. At present, small rectal NETs without high-risk factors are typically treated by local resection, including endoscopic mucosal resection, endoscopic submucosal dissection, or transanal endoscopic microsurgery, with or without additional imaging follow-up by abdominal computed tomography or magnetic resonance imaging. The present study, however, describes a case of a small rectal NET without any known risk factors, which was accompanied by substantial locoregional lymph node metastasis, underscoring the importance of imaging studies for rectal NETs.
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Affiliation(s)
- Seung-Joo Nam
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Gangwon 24289, Republic of Korea
| | - Gi Bong Chae
- Department of Surgery, Kangwon National University School of Medicine, Chuncheon, Gangwon 24289, Republic of Korea
| | - Seungkoo Lee
- Department of Pathology, Kangwon National University School of Medicine, Chuncheon, Gangwon 24289, Republic of Korea
| | - Sung Chul Park
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Gangwon 24289, Republic of Korea
| | - Chang Don Kang
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Gangwon 24289, Republic of Korea
| | - Sung Joon Lee
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Gangwon 24289, Republic of Korea
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13
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Predictive Factors for Lymph Node Metastasis and Prognostic Factors for Survival in Rectal Neuroendocrine Tumors. J Gastrointest Surg 2017; 21:2066-2074. [PMID: 29047070 DOI: 10.1007/s11605-017-3603-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/25/2017] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Neuroendocrine tumors have malignant potential, and lymph node metastasis can occur. This study aimed to identify predictive factors of lymph node metastasis and prognostic factors for survival in rectal neuroendocrine tumors. METHODS Sixty-four patients underwent endoscopic or surgical treatment for rectal NET. The data on these patients were collected in our database prospectively and reviewed retrospectively. RESULTS Transanal excision was performed in 28 (43.8%) patients, endoscopic mucosal resection or submucosal dissection was performed in 15 (23.4%) patients, and radical resection was performed in 21 (31.8%) patients. Lymph node and distant metastasis was present in 16 (25.0%) and fir (7.8%) patients. The significant risk factors for lymph node metastasis identified in the multivariable analyses were tumor size (≥ 2 cm, p = 0.003) and tumor grade (G2, p < 0.001; G3, p = 0.008). In patients with a tumor smaller than 2 cm, the risk factors for lymph node metastasis included the tumor grade, mitosis count, and Ki-67 index. The median follow-up period was 30.0 months, and recurrence developed in four (6.8%) patients. The significant prognostic factors for survival included tumor size, T stage, lymph node metastasis, and tumor grade. CONCLUSION Tumor grade combined with tumor size is an important predictive factor for lymph node metastasis and could serve as a prognostic factor for survival outcomes.
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Xu G, Wang P, Xiao Y, Wu X, Lin G. Local resection of rectal neuroendocrine tumor with first clinical manifestation of giant liver metastasis by transanal endoscopic microsurgery: A case report. Medicine (Baltimore) 2017; 96:e9153. [PMID: 29390320 PMCID: PMC5815732 DOI: 10.1097/md.0000000000009153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
RATIONALE Rectal neuroendocrine tumor (NET) is a relatively rare tumor. Well-differentiated NETs (G1 and G2) rarely display distant metastasis at initial diagnosis. Currently, treatment for the primary lesions of rectal NETs with liver metastasis remains controversial. The liver metastasis was resected in local hospital. Transanal endoscopic microsurgery (TEM) has emerged as an effective minimally invasive surgery for local resection of lower rectal lesions. Herein, we reported the initial application of TEM to remove the rectal primary lesion in patients with low rectal NETs (G2) with giant liver metastases. PATIENT CONCERNS The patient, a 45-year-old woman, was primarily diagnosed with hepatocellular carcinoma and underwent curative resection of a giant liver lesion in a local hospital. Nevertheless, the postoperative pathologic examination revealed that the lesion was an NET (G2). The colonoscopy then showed a nodule 1.4 cm in diameter, 4 cm above the anal verge, located on the anterior wall of the rectum. The biopsy revealed that the nodule was also an NET (G2). However, the patient did not consent to abdominoperineal resection based on concerns for quality of life. DIAGNOSES Rectal NET with liver metastasis. INTERVENTIONS The patient underwent curative resection of liver metastasis. And, TEM was adopted to resect the primary tumor in rectum. OUTCOMES The patient has been disease-free for 2 years with a good quality of life and presents no local recurrence in the rectum. LESSONS TEM is an appropriate palliative operation for therapy of rectal NETs with distant metastases, especially for primary rectal NETs located in low rectal.
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Affiliation(s)
| | - Peipei Wang
- Department of General Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China
| | | | - Xin Wu
- Department of General Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China
| | - Guole Lin
- Department of General Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China
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15
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Okubo Y, Kasajima R, Suzuki M, Miyagi Y, Motohashi O, Shiozawa M, Yoshioka E, Washimi K, Kawachi K, Kameda Y, Yokose T. Risk factors associated with the progression and metastases of hindgut neuroendocrine tumors: a retrospective study. BMC Cancer 2017; 17:769. [PMID: 29145818 PMCID: PMC5693490 DOI: 10.1186/s12885-017-3769-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/09/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The worldwide incidence of neuroendocrine tumors (NETs) has increased remarkably, with the hindgut being the second most common site for such tumors. However, the mechanisms underlying progression and metastasis of hindgut NETs are unclear. A retrospective study was conducted to elucidate these mechanisms. METHODS Clinicopathological data of cases of hindgut NET between April 1996 and September 2015 were analyzed, retrospectively. Patients with neuroendocrine carcinoma were excluded. Formalin-fixed paraffin-embedded tissues of hindgut NET cases were subjected to detailed morphometric and immunohistochemical analyses. Statistical analyses were performed using the non-parametric Mann-Whitney U test, Spearman's correlation coefficient, and chi-squared test. Multivariate logistic regression analysis was conducted as appropriate for the data set. RESULTS Fifty-six hindgut NET cases were considered. Microvessel density and lymphatic microvessel density were identified as significant risk factors for venous and lymphatic invasion. There was a positive correlation between microvessel density and the maximum tumor diameter. Multivariate logistic regression analysis revealed that the maximum tumor diameter alone was an independent predictor of lymph node metastasis, whereas lymphovascular invasion and MVD was not the predictor of lymph node metastasis. There were no significant correlations between the Ki-67 labeling index and any of the parameters evaluated including age, sex, the maximum tumor diameter, venous invasion, lymphatic invasion, microvessel density, lymphatic microvessel density, and lymph node metastasis. CONCLUSIONS Angiogenic mechanisms may play important roles in the progression of hindgut NET. Otherwise, the maximum tumor diameter alone was an independent predictor of lymph node metastasis in hindgut NETs. Moreover, our study raises the question of whether the presence of lymphovascular invasion, in endoscopically obtained hindgut NET tissues, is an absolute indication for additional surgery or not.
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Affiliation(s)
- Yoichiro Okubo
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan.
| | - Rika Kasajima
- Molecular Pathology and Genetics Division, Kanagawa Cancer Center Research Institute, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Masaki Suzuki
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Yohei Miyagi
- Molecular Pathology and Genetics Division, Kanagawa Cancer Center Research Institute, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Osamu Motohashi
- Department of Gastroenterology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Manabu Shiozawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Emi Yoshioka
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Kota Washimi
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Kae Kawachi
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Yoichi Kameda
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Tomoyuki Yokose
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
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16
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Short- and Long-term Outcomes of Laparoscopic Total Mesenteric Excision for Neuroendocrine Tumors of the Rectum. Dis Colon Rectum 2017; 60:284-289. [PMID: 28177990 DOI: 10.1097/dcr.0000000000000745] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND To our knowledge, no studies to date have assessed the short- and long-term outcomes of laparoscopic total mesenteric excision in patients with neuroendocrine tumors of the rectum. OBJECTIVE The purpose of this study was to investigate the short- and long-term outcomes of patients who underwent laparoscopic rectal resection plus total mesenteric excision for rectal neuroendocrine tumors at our institution. DESIGN This was a single center, retrospective study. SETTINGS The study was conducted at a tertiary care facility. PATIENTS Eight-two patients with neuroendocrine tumors who underwent rectal resection with total mesenteric excision, 77 laparoscopically, between June 2005 and August 2015 were included. INTERVENTIONS Laparoscopic rectal resection and total mesenteric excision were the study interventions. MAIN OUTCOME MEASURES Demographic characteristics and surgical and postoperative outcomes were measured. RESULTS Median tumor size was 8.8 mm (range, 3.0-35.0 mm); 63.6% of tumors were located in the lower rectum, with the median distance from the tumor to the anal verge being 50.0 mm (range, 20.0-130.0 mm). Anal preservation was achieved in all of the patients. Anastomotic leakage occurred in 5 patients (6.5%), but there were no deaths. Seventy-one patients (92.2%) had tumor invasion confined to the submucosa. Lymph node metastasis was present in 29 patients (37.7%), including 26 (33.8%) with perirectal and 5 (6.5%) with lateral lymph node metastasis. The median follow-up period in 59 patients was 42 months (range, 11-113 months), and the 3-year overall survival rate was 97.8%. LIMITATIONS The study was limited by its single-center, retrospective analysis. CONCLUSIONS Laparoscopic rectal resection with total mesenteric excision is safe in patients with rectal neuroendocrine tumors, with good short- and long-term outcomes. Because rectal neuroendocrine tumors are smaller and show superficial invasion, the rate of anal preservation may be high.
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17
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Kwon MJ, Kang HS, Soh JS, Lim H, Kim JH, Park CK, Park HR, Nam ES. Lymphovascular invasion in more than one-quarter of small rectal neuroendocrine tumors. World J Gastroenterol 2016; 22:9400-9410. [PMID: 27895428 PMCID: PMC5107704 DOI: 10.3748/wjg.v22.i42.9400] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 09/10/2016] [Accepted: 10/10/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To identify the frequency, clinicopathological risk factors, and prognostic significance of lymphovascular invasion (LVI) in endoscopically resected small rectal neuroendocrine tumors (NETs).
METHODS Between June 2005 and December 2015, 104 cases of endoscopically resected small (≤ 1 cm) rectal NET specimens at Hallym University Sacred Heart Hospital in Korea were retrospectively evaluated. We compared the detected rate of LVI in small rectal NET specimens by two methods: hematoxylin and eosin (H&E) and ancillary immunohistochemical staining (D2-40 and Elastica van Gieson); in addition, LVI detection rate difference between endoscopic procedures were also evaluated. Patient characteristics, prognosis and endoscopic resection results were reviewed by medical charts.
RESULTS We observed LVI rates of 25.0% and 27.9% through H&E and ancillary immunohistochemical staining. The concordance rate between H&E and ancillary studies was 81.7% for detection of LVI, which showed statistically strong agreement between two methods (κ = 0.531, P < 0.001). Two endoscopic methods were studied, including endoscopic submucosal resection with a ligation device and endoscopic submucosal dissection, and no statistically significant difference in the LVI detection rate was detected between the two (26.3% and 26.8%, P = 0.955). LVI was associated with large tumor size (> 5 mm, P = 0.007), tumor grade 2 (P = 0.006). Among those factors, tumor grade 2 was the only independent predictive factor for the presence of LVI (HR = 4.195, 95%CI: 1.321-12.692, P = 0.015). No recurrence was observed over 28.8 mo regardless of the presence of LVI.
CONCLUSION LVI may be present in a high percentage of small rectal NETs, which may not be associated with short-term prognosis.
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18
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Kim JS, Kim YJ, Chung JW, Kim JH, Kim KO, Kwon KA, Park DK, An JS. Usefulness of endoscopic resection using the band ligation method for rectal neuroendocrine tumors. Intest Res 2016; 14:164-71. [PMID: 27175117 PMCID: PMC4863050 DOI: 10.5217/ir.2016.14.2.164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 10/19/2015] [Accepted: 10/20/2015] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Rectal neuroendocrine tumors (NETs) are among the most common of gastrointestinal NETs. Due to recent advances in endoscopy, various methods of complete endoscopic resection have been introduced for small (≤10 mm) rectal NETs. However, there is a debate about the optimal treatment for rectal NETs. In our study, we aimed to evaluate the efficacy and feasibility of endoscopic resection using pneumoband and elastic band (ER-BL) for rectal NETs smaller than 10 mm in diameter. Methods A total of 55 patients who were diagnosed with rectal NET from January 2004 to December 2011 at Gil Medical Center were analyzed retrospectively. Sixteen patients underwent ER-BL. For comparison, 39 patients underwent conventional endoscopic mucosal resection (EMR). Results There was a markedly lower deep margin positive rate for ER-BL than for conventional EMR (6% [1/16] vs. 46% [18/39], P=0.029). Four patients who underwent conventional EMR experienced perforation or bleeding. However, they recovered within a few days. On the other hand, patients whounderwent endoscopic resection using a pneumoband did not experience any complications. In multivariate analysis, ER-BL (P=0.021) was independently associated with complete resection. Conclusions ER-BL is an effective endoscopic treatment with regards to deep margin resection for rectal NET smaller than 10 mm.
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Affiliation(s)
- Ju Seung Kim
- Department of Internal Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, Korea
| | - Yoon Jae Kim
- Department of Internal Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, Korea
| | - Jun-Won Chung
- Department of Internal Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, Korea
| | - Jung Ho Kim
- Department of Internal Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, Korea
| | - Kyoung Oh Kim
- Department of Internal Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, Korea
| | - Kwang An Kwon
- Department of Internal Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, Korea
| | - Dong Kyun Park
- Department of Internal Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, Korea
| | - Jung Suk An
- Department of Pathology, Gachon University College of Medicine, Gil Medical Center, Incheon, Korea
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19
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Excellent prognosis following endoscopic resection of patients with rectal neuroendocrine tumors despite the frequent presence of lymphovascular invasion. J Gastroenterol 2015; 50:1184-9. [PMID: 25936647 DOI: 10.1007/s00535-015-1079-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 04/06/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic resection (ER) has been increasingly used for the treatment of rectal neuroendocrine tumors (NETs); however, only limited data are available on its long-term outcomes. This study analyzed the long-term outcomes of rectal NETs treated by ER and characterized potential risk factors for metastasis in these cases, with emphasis on lymphovascular invasion. METHODS We retrospectively analyzed the clinicopathological features and outcomes of 86 patients with 90 rectal NETs who had been treated by ER. Lymphovascular invasion was reevaluated using elastic-staining and double-staining immunohistochemistry. RESULTS En bloc resection with tumor-free margins was achieved in 87 lesions (96.7%). The median tumor size was 5 mm (range 2-13), and all the lesions were confined to the submucosal layer. The Ki-67 index was less than 3% in all the lesions, which were therefore classified as NET G1. Elastic-staining and double-staining immunohistochemistry revealed the presence of lymphatic and venous invasion in 23 (25.6%) and 35 lesions (36.7%), respectively. Collectively, lymphatic and/or vascular invasion was identified in 42 lesions (46.7%). All cases were followed up without additional surgery, and no metastasis or recurrence was detected during the median follow-up period of 67.5 months. CONCLUSIONS This study showed an excellent long-term prognosis following ER of patients with rectal NETs, confirming that ER is a valid treatment option for small rectal NETs. The present study also revealed highly prevalent lymphovascular invasion even in minute rectal NETs; this observation raises a question regarding its significance as a risk factor for metastasis.
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Dilemmas in Endoscopic Management of Rectal Neuroendocrine Tumors: A Case-Based Discussion. Gastroenterol Res Pract 2015; 2015:539861. [PMID: 26346026 PMCID: PMC4541008 DOI: 10.1155/2015/539861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 07/12/2015] [Indexed: 12/20/2022] Open
Abstract
Rectal neuroendocrine tumors are uncommon neoplasms that historically were regarded as having an indolent course. Due to the widespread use of screening colonoscopy neuroendocrine tumors of the rectum are identified with increasing frequency. More recent literature has suggested that rectal neuroendocrine tumors may progress in a more malignant fashion than previously believed. In this case-based discussion we present management dilemmas, analyze current guidelines, and highlight the role of endoscopic ultrasound, endoscopic resection, and surgery.
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Sohn JH, Cho MY, Park Y, Kim H, Kim WH, Kim JM, Jung ES, Kim KM, Lee JH, Chan HK, Park DY, Joo M, Kim S, Moon WS, Kang MS, Jin SY, Kang YK, Yoon SO, Han H, Choi E. Prognostic Significance of Defining L-Cell Type on the Biologic Behavior of Rectal Neuroendocrine Tumors in Relation with Pathological Parameters. Cancer Res Treat 2015; 47:813-22. [PMID: 25715764 PMCID: PMC4614207 DOI: 10.4143/crt.2014.238] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/04/2014] [Indexed: 02/08/2023] Open
Abstract
Purpose In 2010, the World Health Organization categorized L-cell type neuroendocrine tumors (NETs) as tumors of uncertain malignancy, while all others were classified as malignant. However, the diagnostic necessity of L-cell immunophenotyping is unclear, as are tumor stage and grade that may guide diagnosis and management. To clarify the predictive markers of rectal neuroendocrine neoplasms (NENs), 5- and 10-year overall survival (OS) was analyzed by pathological parameters including L-cell phenotype. Materials and Methods A total of 2,385 rectal NENs were analyzed from our previous multicenter study and a subset of 170 rectal NENs was immunophenotyped. Results In univariate survival analysis, tumor grade (p < 0.0001), extent (p < 0.0001), size (p < 0.0001), lymph node metastasis (p=0.0063), and L-cell phenotype (p < 0.0001) showed significant correlation with the prognosis of rectal NENs; however, none of these markers achieved independent significance in multivariate analysis. The 10-year OS of tumors of NET grade 1, < 10 mm, the mucosa/submucosa was 97.58%, 99.47%, and 99.03%, respectively. L-Cell marker, glucagon II (GLP-1&2), with a cut off score of > 10, is useful in defining L-Cell type. In this study, an L-cell immunophenotype was found in 83.5% of all rectal NENs and most, but not all L-cell type tumors were NET G1, small (< 10 mm) and confined to the mucosa/submucosa. Conclusion From these results, the biological behavior of rectal NENs does not appear to be determined by L-cell type alone but instead by a combination of pathological parameters.
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Affiliation(s)
| | - Jin Hee Sohn
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mee-Yon Cho
- Department of Pathology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yangsoon Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyunki Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Ho Kim
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Joon Mee Kim
- Department of Pathology, Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Eun Sun Jung
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung-Mee Kim
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyuk Lee
- Department of Pathology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Hee Kyung Chan
- Department of Pathology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Do Youn Park
- Department of Pathology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Mee Joo
- Department of Pathology, Inje University Ilsan Paik Hospital, Inje Univeristy College of Medicine, Goyang, Korea
| | - Sujin Kim
- Department of Pathology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Woo Sung Moon
- Department of Pathology, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Mi Seon Kang
- Department of Pathology, Inje University Busan Paik Hospital,Inje University College of Medicine, Busan, Korea
| | - So-Young Jin
- Department of Pathology, Soon Chun Hyang University Hospital, Soon Chun Hyang University College of Medicine, Seoul, Korea
| | - Yun Kyung Kang
- Department of Pathology, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sun Och Yoon
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - HyeSeung Han
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - EunHee Choi
- Division of Statistics in Institute of ifestyle Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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22
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Endoscopically identified well-differentiated rectal carcinoid tumors: impact of tumor size on the natural history and outcomes. Gastrointest Endosc 2014; 80:144-51. [PMID: 24462168 DOI: 10.1016/j.gie.2013.11.031] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 11/20/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is a paucity of data pertaining to the natural history and outcomes of patients with well-differentiated rectal carcinoids. OBJECTIVE To correlate endoscopic size with the natural history and outcome. DESIGN Retrospective study. SETTING Single tertiary referral center. PATIENTS Eighty-seven patients with endoscopically identified well-differentiated rectal carcinoid tumors. INTERVENTION Colonoscopy. MAIN OUTCOME MEASUREMENTS Prevalence of metastasis at diagnosis, disease progression, and survival. RESULTS Metastasis was present at diagnosis in 3%, 66%, and 73% of tumors measuring ≤10 mm, 11 to 19 mm, and ≥20 mm, respectively. Metastasis was predicted with 100% sensitivity and 87% specificity using an endoscopic lesion size ≥9 mm. In patients without identified metastasis, 64% were identified during screening colonoscopy. Within this select cohort, subsequent metastasis was discovered only at distant extra pelvic sites, in 1.6%, 50%, and 100% of patients with tumors initially measuring ≤10 mm, 11 to 19 mm, and ≥20 mm, respectively. The carcinoid related 5- and 10-year survival rates for locally confined disease were 96%. The corresponding survival rates for local and advanced metastatic disease were 60% and 35%, respectively. LIMITATIONS Subjective estimation of tumor size, mitotic index or Ki-67 labeling index not reported, and lack of formal and standardized baseline staging algorithm and surveillance program. CONCLUSIONS The clinical behavior of 11- to 19-mm tumors appears to mimic that of larger (>20 mm) lesions with respect to the presence of metastasis at diagnosis and disease progression. Therefore, if local therapy is contemplated, we propose to make a distinction between ≤10-mm and 11- to 19-mm tumors, favoring an aggressive staging and management protocol for 11- to 19-mm carcinoid tumors.
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23
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Pittayanon R, Pantongrag-Brown L, Wisedopas N, Rerknimitr R. Asymptomatic primary rectal neuroendocrine carcinoma presented as a large pelvic mass. BMJ Case Rep 2014; 2014:bcr-2013-200491. [PMID: 24493107 DOI: 10.1136/bcr-2013-200491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 55-year-old healthy Thai man presented with incidental finding of a well-circumscribed, 5.8×5.4 cm mass in the right side of the pelvic cavity with heterogeneous density by a CT scan performed for trauma. No other distant lesion was detected. The pathology from pelvic mass showed poorly differentiated neuroendocrine carcinoma (NEC). A submucosal mass of 10 cm from the anal verge was found at colonoscopy, and a biopsy showed the same histopathology as in the pelvic mass. Final diagnosis was poorly differentiated primary rectal NEC with metastasis to the right iliac node (by CT scan). Carboplatin and etoposide were given for six cycles and tumour size was decreased.
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Affiliation(s)
- Rapat Pittayanon
- Department of Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand
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24
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Factors associated with lymph node metastasis in radically resected rectal carcinoids: a systematic review and meta-analysis. J Gastrointest Surg 2013; 17:1689-97. [PMID: 23818123 DOI: 10.1007/s11605-013-2249-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 06/10/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although various guidelines regarding neuroendocrine tumors were released, treatment for rectal neuroendocrine tumors with size between 1 and 2 cm has not been explicitly elucidated. The determinant factor of the choice between endoscopic resection and radical surgery is whether lymph node involvement exists. AIM This study aims to explore factors associated with lymph node involvement in rectal neuroendocrine tumors by conducting a meta-analysis. METHODS A broad literature research of Pubmed, Embase&Medline, and The Cochrane Library was performed, and systematic review and meta-analysis about factors associated with lymph node involvement were conducted. RESULTS Seven studies were included in this meta-analysis. Tumor size > 1 cm (odds ratio (OR) 6.72, 95% confidence interval (CI) [3.23, 14.02]), depth of invasion (OR 5.06, 95% CI [2.30, 11.10]), venous invasion (OR 5.92, 95% CI [2.21, 15.87]), and central depression (OR 3.00, 95% CI [1.07, 8.43]) were significantly associated with lymph node involvement. CONCLUSION The available clinical evidence suggests that tumor size > 1 cm, invasion of muscularis properia, venous invasion, and central depression could be risk factors of lymph node involvement, while other factors reported by few studies need further research.
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