open access

Vol 71, No 1 (2021)
Research paper (original)
Published online: 2021-01-05
Get Citation

Local excision vs. radical surgery in treating rectal nets considering the biology of neuroendocrine tumors (NETs)

Mykola Zubaryev1, Ho Seung Kim Seung Kim2, Byung Soh Min2
DOI: 10.5603/NJO.a2021.0001
·
Nowotwory. Journal of Oncology 2021;71(1):9-16.
Affiliations
  1. Department of the Abdominal Tumors, National Cancer Institute, Kyiv, Ukraine
  2. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea

open access

Vol 71, No 1 (2021)
Original article
Published online: 2021-01-05

Abstract

Introduction. Local excision (LE) is performed for rectal neuroendocrine tumors (NETs) <1 cm in size, whereas radical surgery (RS) is performed for larger tumors. The lack of data and limited number of studies support such approaches. Thus, we determined oncological outcomes after primary tumor resection in patients with rectal NETs and identified other factors of NETs that could influence oncological outcomes.

Material and methods. We retrospectively examined patients with I–III stage rectal NETs who underwent different surgical approaches, including LE or RS, in Severance Hospital, Korea between 2006 and 2017. The association between surgery extent, tumor size (TS), depth of invasion and biological factors of NETs was examined. Oncological outcomes were analyzed.

Results. Local excision (LE) and radical surgery (RS) were performed in 64 and 23 patients, respectively. Patients who underwent RS were more likely to have larger TS; deeper invasion; higher grade, mitotic index, Ki-67; more lymph node metastasis (LNMts); and a higher lymphovascular invasion rate (p < 0.001). Most patients with TS < 1.0 cm underwent LE had better DFS and OS. Primary TS > 10 mm was an independent predictor of invasion (p = 0.001) whereas depth of invasion was an independent predictor of LN metastases (p = 0.003). In the multivariate analysis, only invasion was an independent factor associated with poor DFS and OS (p = 0.023 and 0.015, respectively).

Conclusions. Local excision could be an effective method to use in treating rectal NETs in the early stage of the disease, and depth of invasion was an important factor influencing oncological outcomes. Our findings need to be confirmed in future prospective and randomized studies.

Abstract

Introduction. Local excision (LE) is performed for rectal neuroendocrine tumors (NETs) <1 cm in size, whereas radical surgery (RS) is performed for larger tumors. The lack of data and limited number of studies support such approaches. Thus, we determined oncological outcomes after primary tumor resection in patients with rectal NETs and identified other factors of NETs that could influence oncological outcomes.

Material and methods. We retrospectively examined patients with I–III stage rectal NETs who underwent different surgical approaches, including LE or RS, in Severance Hospital, Korea between 2006 and 2017. The association between surgery extent, tumor size (TS), depth of invasion and biological factors of NETs was examined. Oncological outcomes were analyzed.

Results. Local excision (LE) and radical surgery (RS) were performed in 64 and 23 patients, respectively. Patients who underwent RS were more likely to have larger TS; deeper invasion; higher grade, mitotic index, Ki-67; more lymph node metastasis (LNMts); and a higher lymphovascular invasion rate (p < 0.001). Most patients with TS < 1.0 cm underwent LE had better DFS and OS. Primary TS > 10 mm was an independent predictor of invasion (p = 0.001) whereas depth of invasion was an independent predictor of LN metastases (p = 0.003). In the multivariate analysis, only invasion was an independent factor associated with poor DFS and OS (p = 0.023 and 0.015, respectively).

Conclusions. Local excision could be an effective method to use in treating rectal NETs in the early stage of the disease, and depth of invasion was an important factor influencing oncological outcomes. Our findings need to be confirmed in future prospective and randomized studies.

Get Citation

Keywords

rectal neuroendocrine tumor; local excision; radical surgery; invasion; tumor size

About this article
Title

Local excision vs. radical surgery in treating rectal nets considering the biology of neuroendocrine tumors (NETs)

Journal

Nowotwory. Journal of Oncology

Issue

Vol 71, No 1 (2021)

Article type

Research paper (original)

Pages

9-16

Published online

2021-01-05

DOI

10.5603/NJO.a2021.0001

Bibliographic record

Nowotwory. Journal of Oncology 2021;71(1):9-16.

Keywords

rectal neuroendocrine tumor
local excision
radical surgery
invasion
tumor size

Authors

Mykola Zubaryev
Ho Seung Kim Seung Kim
Byung Soh Min

References (28)
  1. Fraenkel M, Kim M, Faggiano A, et al. Knowledge NETwork. Incidence of gastroenteropancreatic neuroendocrine tumours: a systematic review of the literature. Endocr Relat Cancer. 2014; 21(3): R153–R163.
  2. Dasari A, Shen C, Halperin D, et al. Trends in the Incidence, Prevalence, and Survival Outcomes in Patients With Neuroendocrine Tumors in the United States. JAMA Oncol. 2017; 3(10): 1335–1342.
  3. Maggard MA, O'Connell JB, Ko CY. Updated population-based review of carcinoid tumors. Ann Surg. 2004; 240(1): 117–122.
  4. Ezekian B, Adam MA, Turner MC, et al. Local excision results in comparable survival to radical resection for early-stage rectal carcinoid. J Surg Res. 2018; 230: 28–33.
  5. McDermott FD, Heeney A, Courtney D, et al. Rectal carcinoids: a systematic review. Surg Endosc. 2014; 28(7): 2020–2026.
  6. Shah MH, Goldner WS, Halfdanarson TR, et al. NCCN Guidelines Insights: Neuroendocrine and Adrenal Tumors, Version 2.2018. J Natl Compr Canc Netw. 2018; 16(6): 693–702.
  7. Delle Fave G, O'Toole D, Sundin A, et al. Vienna Consensus Conference participants. ENETS Consensus Guidelines Update for Gastroduodenal Neuroendocrine Neoplasms. Neuroendocrinology. 2016; 103(2): 119–124.
  8. Wei R, Lo OSH, Law WL. Surgical management and outcome of rectal carcinoids in a university hospital. World J Surg Oncol. 2015; 13: 31.
  9. Yangong H, Shi C, Shahbaz M, et al. Diagnosis and treatment experience of rectal carcinoid (a report of 312 cases). Int J Surg. 2014; 12(5): 408–411.
  10. Choi CW, Park SuB, Kang DH, et al. The clinical outcomes and risk factors associated with incomplete endoscopic resection of rectal carcinoid tumor. Surg Endosc. 2017; 31(12): 5006–5011.
  11. Choi AH, Kim J, Chao J. Perioperative chemotherapy for resectable gastric cancer: MAGIC and beyond. World J Gastroenterol. 2015; 21(24): 7343–7348.
  12. Takatsu Y, Fukunaga Y, Nagasaki T, et al. Short- and Long-term Outcomes of Laparoscopic Total Mesenteric Excision for Neuroendocrine Tumors of the Rectum. Dis Colon Rectum. 2017; 60(3): 284–289.
  13. Park HW, Byeon JS, Park YS, et al. Endoscopic submucosal dissection for treatment of rectal carcinoid tumors. Gastrointest Endosc. 2010; 72(1): 143–149.
  14. Kim JuS, Kim YJ, Chung JW, et al. Usefulness of endoscopic resection using the band ligation method for rectal neuroendocrine tumors. Intest Res. 2016; 14(2): 164–171.
  15. Lee HJ, Kim SB, Shin CM, et al. A comparison of endoscopic treatments in rectal carcinoid tumors. Surg Endosc. 2016; 30(8): 3491–3498.
  16. Yang DH, Park Y, Park SH, et al. Cap-assisted EMR for rectal neuroendocrine tumors: comparisons with conventional EMR and endoscopic submucosal dissection (with videos). Gastrointest Endosc. 2016; 83(5): 1015–22; quiz 1023.
  17. Chen Ru, Liu X, Sun S, et al. Comparison of Endoscopic Mucosal Resection With Circumferential Incision and Endoscopic Submucosal Dissection for Rectal Carcinoid Tumor. Surg Laparosc Endosc Percutan Tech. 2016; 26(3): e56–e61.
  18. He L, Deng T, Luo H. Efficacy and safety of endoscopic resection therapies for rectal carcinoid tumors: a meta-analysis. Yonsei Med J. 2015; 56(1): 72–81.
  19. Kumar AS, Sidani SM, Kolli K, et al. Transanal endoscopic microsurgery for rectal carcinoids: the largest reported United States experience. Colorectal Dis. 2012; 14(5): 562–566.
  20. Zhou JL, Lin GL, Zhao DC, et al. Resection of multiple rectal carcinoids with transanal endoscopic microsurgery: case report. World J Gastroenterol. 2015; 21(7): 2220–2224.
  21. Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer. 2003; 97(4): 934–959.
  22. Modlin IM, Oberg K, Chung DC, et al. Gastroenteropancreatic neuroendocrine tumours. Lancet Oncol. 2008; 9(1): 61–72.
  23. Caplin ME, Pavel M, Ćwikła JB, et al. CLARINET Investigators. Lanreotide in metastatic enteropancreatic neuroendocrine tumors. N Engl J Med. 2014; 371(3): 224–233.
  24. Gleeson FC, Levy MJ, Dozois EJ, et al. Endoscopically identified well-differentiated rectal carcinoid tumors: impact of tumor size on the natural history and outcomes. Gastrointest Endosc. 2014; 80(1): 144–151.
  25. Park CH, Cheon JH, Kim JO, et al. Criteria for decision making after endoscopic resection of well-differentiated rectal carcinoids with regard to potential lymphatic spread. Endoscopy. 2011; 43(9): 790–795.
  26. McConnell YJ. Surgical management of rectal carcinoids: trends and outcomes from the Surveillance, Epidemiology, and End Results database (1988 to 2012). Am J Surg. 2016; 211(5): 877–885.
  27. Kasuga A, Chino A, Uragami N, et al. Treatment strategy for rectal carcinoids: a clinicopathological analysis of 229 cases at a single cancer institution. J Gastroenterol Hepatol. 2012; 27(12): 1801–1807.
  28. Avenel P, McKendrick A, Silapaswan S, et al. Gastrointestinal carcinoids: an increasing incidence of rectal distribution. Am Surg. 2010; 76(7): 759–763.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Wydawcą serwisu jest VM Media sp. z o.o. VM Group sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl