Endoscopic mucosal resection: still a reliable therapeutic option for gastrointestinal neuroendocrine tumors

BMC Gastroenterology

Ali Reza Taghavi¹  Gholam Reza Sivandzadeh¹  Fardad Ejtehadi¹  Ramin Niknam¹  Bita Geramizadeh²  Ali Reza Safarpour³  Ladan Aminlari⁴  Ahmad Hormati⁵  Kamran Bagheri Lankarani⁶  Shima Shoaee⁷ 

[1] Department of Internal Medicine, Gastroenterohepatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Fars, Iran;Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Fars, Iran;Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran;Gastroentrohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran;Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Firozgar Hospital, Tehran, Iran;Health Policy Research Center, School of Medicine, Institute of Health, Shiraz University of Medical Sciences, Building No. 2, Eighth Floor, Zand Avenue, 71345-1414, Shiraz, Fars, Iran;School of Medicine, Shiraz University of Medical Sciences, Shiraz, Fars, Iran;

关键词: Endoscopic mucosal resection;    Neuroendocrine tumors;    Gastrointestinal NET;    NET;    ESD;   

DOI  :  10.1186/s12876-021-01821-6

来源: Springer

【 摘 要 】

BackgroundNeuroendocrine tumors (NETs), as a rare and heterogeneous category of solid tumors, feature various morphologies and behaviors. In recent years, the incidence of NETs has continued to increase. Endoscopic mucosal resection (EMR) is one of the therapeutic modalities for the treatment of gastric and rectal NETs.MethodsWe evaluated patients with well-differentiated NETs of the stomach, duodenum, or rectum between 2011 and 2018. In this study, all cases with tumors confined to the mucosal or submucosal layers and smaller than 20 mm were resected using the EMR technique. We used EUS, CT scan, or MRI to exclude patients with advanced disease. All patients were actively monitored for recurrence according to the recommended protocols.ResultsA total of 36 patients with NETs entered the study; 17 (47.2%) were female and the remaining 19 (52.8%) were male, with a total age range of 20–74 years (mean: 52.47 ± 13.47 years). Among the tumors, 31 cases (86.1%) were G1 and the remaining 5 (13.9%) were G2. Based on the pathology reports, 22 tumors (61.1%) were smaller than 1 cm, while the remaining 14 (38.9%) were between 1–2 cm. Twenty-two patients (61.1%) had a margin of specimen involved with the tumor. No recurrence was observed during the mean follow-up time of 63.5 ± 19.8 months (range: 39–103 months). All 36 cases survived during the study period.ConclusionConventional EMR procedure provides low chance of R0 (complete resection) achievement in gastrointestinal NETs smaller than 20 mm and limited to the mucosa or sub mucosa. However, it could be an option if patients are closely followed. Postoperative marginal involvement is not a reliable predictor of disease recurrence, which may be explained by the deleterious effect of heat coagulation and cauterization applied during tumor removal.

【 授权许可】

CC BY