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

01-03-2021 | Metastasis | Original Article

Endoscopically removed rectal NETs: a nationwide cohort study

Authors: Teaco Kuiper, M. G. H. van Oijen, M. F. van Velthuysen, N. van Lelyveld, M. E. van Leerdam, F. D. Vleggaar, H. J. Klümpen

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

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Abstract

Purpose

Rectal neuroendocrine tumours (NETs) often present as an incidental finding during colonoscopy. Complete endoscopic resection of low-grade NETs up to 10 mm is considered safe. Whether this is also safe for NETs up to 20 mm is unclear. We performed a nationwide study to determine the risk of lymph node and distant metastases in endoscopically removed NETs.

Methods

All endoscopically removed rectal NETs between 1990 and 2010 were identified using the national pathology database (PALGA). Each NET was stratified according to size, grade and resection margin. Follow-up was until February 2016.

Results

Between 1990 and 2010, a total of 310 NETs smaller than 20 mm were endoscopically removed. Mean size of NETs was 7.4 mm (SD 3.5). In 49% of NETs (n = 153), no grade (G) could be assessed from the pathology report, 1% was G2 (n = 3), and the remaining NETs were G1. Median follow up was 11.6 years (range 4.9–26.0). During follow-up, 30 patients underwent surgical resection. Lymph node or distant metastasis was seen in 3 patients (1%) which all had a grade 2 NET. Mean time from endoscopic resection to diagnosis of metastases was 6.1 years (95% CI 2.9–9.2).

Conclusion

No lymph node or distant metastases were seen in endoscopically removed G1 NETs up to 20 mm during the long follow-up of this nationwide study. This adds evidence to the ENET guideline that endoscopic resection of G1 NETs up to 20 mm appears to be safe.
Literature
1.
Vassiliki LT, Wertheim B, Guerrero MA et al (2012) Trends of incidence and survival of gastrointestinal neuroendocrine tumors in the United States: a seer analysis. J Cancer 3:292–302CrossRef
2.
Scherübl H (2009) Rectal carcinoids are on the rise: early detection by screening endoscopy. Endoscopy. 41(2):162–165CrossRef
3.
Modlin IM, Lye KD, Kidd M (2003) A 5-decade analysis of 13,715 carcinoid tumors. Cancer. 97(4):934–959CrossRef
4.
Suk Jung Y, Yun KE, Chang Y et al Risk factors associated with rectal neuroendocrine tumors: a cross-sectional study. Cancer Epidemiol Biomark Prev 23(7):1406–1413
5.
Kooyker AI, Verbeek WHM, Van den Berg JG, Tesselaar MET, Van Leerdam ME (2020) Change in incidence, characteristics and management of colorectal neuroendocrine tumours in the Netherlands in the last decade. United European Gastroenterol J 8(1):59–67CrossRef
6.
Le Clercq C, Bouwens M and Riedl R et al Macroscopic features of neuroendocrine colorectal cancers: a 10-year retrospective study. Abstract AGA 2012 Tu1163
7.
Ramage JK, De Herder WW, Delle Fave G et al (2016) ENETS consensus guidelines update for colorectal neuroendocrine neoplasms. Neuroendocrinology 103:139–143CrossRef
8.
Kulke MH, Shah MH, Benson AB et al (2015) Neuroendocrine tumors, version 1.2015. J Natl Compr Cancer Netw 13(1):78–108CrossRef
9.
Anthony LB, Strosberg JR, Klimstra DS, Maples WJ, O'Dorisio TM, Warner RR, Wiseman GA, Benson AB 3rd, Pommier RF, North American Neuroendocrine Tumor Society (NANETS) (2010) The NANETS consensus guidelines for the diagnosis and management of gastrointestinal neuroendocrine tumors (nets): well-differentiated nets of the distal colon and rectum. Pancreas. 39(6):767–774CrossRef
10.
Gleeson FC, Levy MJ, Dozois EJ, Larson DW, Kee Song LMW, Boardman LA (2014) Endoscopically identified well-differentiated rectal carcinoid tumors: impact of tumor size on the natural history and outcomes. Gastrointest Endosc 80(1):144–151CrossRef
11.
Kojima M, Ikeda K, Saito N et al (2016) Neuroendocrine tumors of the large intestine: clinicopathological features and predictive factors of lymph node metastasis. Front Oncol 6:173CrossRef
12.
Kasuga A, Chino A, Uragami N, Kishihara T, Igarashi M, Fujita R, Yamamoto N, Ueno M, Oya M, Muto T (2012) Treatment strategy for rectal carcinoids: a clinicopathological analysis of 229 cases at a single cancer institution. J Gastroenterol Hepatol 27(12):1801–1807CrossRef
13.
Casparie M, Tiebosch AT, Burger G, Blauwgeers H, Van de Pol H, Van Krieken JHJM, Meijer GA (2007) Pathology databanking and biobanking in the Netherlands, a central role for PALGA, the nationwide histopathology and cytopathology data network and archive. Cell Oncol 29:19–24PubMedPubMedCentral
14.
Kaneko H, Hirasawa K, Koh R, Kobayashi R, Kokawa A, Tanaka K, Maeda S (2016) Treatment outcomes of endoscopic resection for rectal carcinoid tumors: an analysis of the resectability and long-term results from 46 consecutive cases. Scand J Gastroenterol 51(12):1489–1494CrossRef
15.
Kim J, Kim JH, Lee JY, Chun J, Im JP, Sung Kim J (2018) Clinical outcomes of endoscopic mucosal resection for rectal neuroendocrine tumor. BMC Gastroenterol 18(1):77CrossRef
16.
Kwaan MR, Goldberg JE, Bleday R (2008) Rectal carcinoid tumors: review of results after endoscopic and surgical therapy. Arch Surg 143(5):471CrossRef
17.
Shirouzu K, Isomoto H, Kakegawa T, Morimatsu M (1990) Treatment of rectal carcinoid tumors. Am J Surg 160(3):262–265CrossRef
18.
Landry CS, Brock G, Scoggins CR, McMasters KM, Martin RCG 2nd (2008) Proposed staging system for colon carcinoid tumors based on an analysis of 2,459 patients. J Am Coll Surg 207(6):874–881CrossRef
19.
Shields CJ, Tiret E, Winter DC (2010) International Rectal Carcinoid Study Group. Carcinoid tumors of the rectum: a multi-institutional international collaboration. Ann Surg 252(5):750–755CrossRef
20.
Anderson BW, Smyrk TC, Anderson KS, Mahoney DW, Devens ME, Sweetser SR, Kisiel JB, Ahlquist DA (2016) Endoscopic overestimation of colorectal polyp size. Gastrointest Endosc 83(1):201–208CrossRef
21.
Weinstock BA, Ward SCB, Harpaz NB, Warner RRP, Itzkowitz S, Kang Kim M (2013) Clinical and prognostic features of rectal neuroendocrine tumors. Neuroendocrinology 98:180–187CrossRef
22.
Al Natour RH, Saund MS, Sanchez VM et al (2012) Tumor size and depth predict rate of lymph node metastasis in colon carcinoids and can be used to select patients for endoscopic resection. J Gastrointest Surg 16(3):595–602CrossRef
23.
Soga J (2005) Early-stage carcinoids of the gastrointestinal tract: an analysis of 1914 reported cases. Cancer. 103(8):1587–1595 ReviewCrossRef
24.
Fahy BN, Tang LH, Klimstra D et al (2006) Carcinoid of the Rectum Risk Stratification (CaRRs): A Strategy for Preoperative Outcome Assessment. Ann Surg Oncol 14(5):1735–1743CrossRef
25.
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 (2019) Prevalence of metastasis and survival of 788 patients with T1 rectal carcinoid tumors. Gastrointest Endosc 89(3):602–606CrossRef
26.
Zhao B, Hollandsworth HM, Lopez NE, Parry LA, Abbadessa B, Cosman BC, Ramamoorthy SL, Eisenstein S (2020) Outcomes for a large cohort of patients with rectal neuroendocrine tumors: an analysis of the national cancer database. J Gastrointest Surg. https://​doi.​org/​10.​1007/​s11605-020-04525-6
27.
Konishi T, Watanabe T, Kishimoto J et al (2007) Prognosis and risk factors of metastasis in colorectal carcinoids: results of a nationwide registry over 15 years. Gut 56(6):86CrossRef
Metadata
Title
Endoscopically removed rectal NETs: a nationwide cohort study
Authors
Teaco Kuiper
M. G. H. van Oijen
M. F. van Velthuysen
N. van Lelyveld
M. E. van Leerdam
F. D. Vleggaar
H. J. Klümpen
Publication date
01-03-2021
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 3/2021
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-020-03801-w

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