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International Journal of Colorectal Disease

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01-03-2021 | Metastasis | Original Article

Risk of lymph node metastasis after endoscopic treatment for rectal NETs 10 mm or less

Authors: Yutaka Inada, Naohisa Yoshida, Kohei Fukumoto, Ryohei Hirose, Ken Inoue, Osamu Dohi, Takaaki Murakami, Kiyoshi Ogiso, Akira Tomie, Munehiro Kugai, Hiroyuki Yoriki, Yoshikazu Inagaki, Daisuke Hasegawa, Kotaro Okuda, Takashi Okuda, Yukiko Morinaga, Mitsuo Kishimoto, Yoshito Itoh

Published in: International Journal of Colorectal Disease | Issue 3/2021

Abstract

Purpose

For rectal neuroendocrine tumors (NETs) ≤ 10 mm, endoscopic resection is a standard treatment. However, there is no consensus whether additional surgery should be performed for patients at risk of lymph node metastasis (LNM) after endoscopic resection. The purpose of this study was to analyze the results of endoscopic resection and additional surgery of rectal NETs, thereby clarify the characteristics of cases with LNM.

Methods

This study was a multicenter retrospective cohort study conducted at 12 Japanese institutions. A total of 132 NETs ≤ 10 mm were analyzed regarding various therapeutic results. A comparative analysis was performed by dividing the cases into two groups that underwent additional surgery or not. Furthermore, the relationship between tumor size and LNM was examined.

Results

The endoscopic treatments were 12 endoscopic mucosal resections (EMR), 58 endoscopic submucosal resections with ligation (ESMR-L), 29 precutting EMRs, and 33 endoscopic submucosal dissections (ESD). The R0 resection rates of EMR were 41.7%, and compared to this rate, other three treatments were 86.2% (p < 0.001), 86.2% (p = 0.005), and 97.0% (p < 0.001), respectively. There were 41 non-curative cases (31.1%), and 13 had undergone additional surgery. Then, LNM was observed in 4 of the 13 patients, with an overall rate of LNM of 3.0% (4/132). The rate of positive lymphatic invasion and the rate of LNM by tumor size ≤ 6 mm and 7–10 mm were 9.7 vs. 15.4% (p = 0.375) and 0 vs. 10.3% (p = 0.007).

Conclusions

A multicenter study revealed the priority of each endoscopic resection and the low rate of LNM for rectal NETs ≤ 6 mm.

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Title: Risk of lymph node metastasis after endoscopic treatment for rectal NETs 10 mm or less
Authors: Yutaka Inada
Naohisa Yoshida
Kohei Fukumoto
Ryohei Hirose
Ken Inoue
Osamu Dohi
Takaaki Murakami
Kiyoshi Ogiso
Akira Tomie
Munehiro Kugai
Hiroyuki Yoriki
Yoshikazu Inagaki
Daisuke Hasegawa
Kotaro Okuda
Takashi Okuda
Yukiko Morinaga
Mitsuo Kishimoto
Yoshito Itoh
Publication date: 01-03-2021
Publisher: Springer Berlin Heidelberg
Keywords: Metastasis
Neuroendocrine Tumor
Published in: International Journal of Colorectal Disease / Issue 3/2021
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-020-03826-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Risk of lymph node metastasis after endoscopic treatment for rectal NETs 10 mm or less

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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