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. 2020 Mar;8(6):368.
doi: 10.21037/atm.2020.02.25.

Efficacy and safety of hybrid endoscopic submucosal dissection compared with endoscopic submucosal dissection for rectal neuroendocrine tumors and risk factors associated with incomplete endoscopic resection

Xiang-Yao Wang  1 , Ning-Li Chai  1 , En-Qiang Linghu  1 , Hui-Kai Li  1 , Ya-Qi Zhai  1 , Xiu-Xue Feng  1 , Wen-Gang Zhang  1 , Jia-Le Zou  1 , Long-Song Li  1 , Jing-Yuan Xiang  1
Affiliations

Efficacy and safety of hybrid endoscopic submucosal dissection compared with endoscopic submucosal dissection for rectal neuroendocrine tumors and risk factors associated with incomplete endoscopic resection

Xiang-Yao Wang et al. Ann Transl Med. 2020 Mar.

Abstract

Background: Neuroendocrine tumors (NETs) are rising in prevalence, particularly with the rectal area. This study evaluated and compared the safety and effectiveness of hybrid endoscopic submucosal dissection (ESD) with those of ESD for rectal NETs and risk factors associated with incomplete endoscopic resection.

Methods: A total of 272 consecutive patients who underwent ESD or hybrid ESD for rectal NETs at the Chinese PLA General Hospital in the period from February 2011 to September 2018 were involved in this study. Data were collected from clinical and endoscopic databases. The procedure time, en bloc resection, complete resection, complication, and recurrence rates were evaluated.

Results: In the hybrid ESD group were 111 patients (who had 119 lesions between them), with a further 161 patients (164 lesions) in the ESD group. No significance was found in baseline characteristics between the two groups. Hybrid ESD had a significantly shorter mean procedure time than ESD (13.2±8.3 vs. 18.1±9.7 min, P=0.000). Hybrid ESD showed similar en bloc resection (99.2% vs. 98.2%; P=0.373), complete resection (94.1% vs. 90.9%, P=0.641), and postprocedural bleeding (2.5% vs. 0.6%, P=0.313) rates to ESD. Univariate and multivariate analysis showed that higher histopathological grade was associated with incomplete resection.

Conclusions: For rectal NET, both ESD and hybrid ESD are effective and safe forms of treatment. Hybrid ESD provides an alternative option in the treatment of rectal NETs. Further developments are needed to improve the complete resection rate, especially concerning tumors with higher histopathological grade.

Keywords: Endoscopic submucosal dissection (ESD); endoscopic resection (ER); hybrid endoscopic submucosal dissection (hybrid ESD); rectal neuroendocrine tumors (NETs).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Hybrid endoscopic submucosal dissection (ESD) of a rectal neuroendocrine tumor (NET). (A) An approximately 10-mm rectal NET; (B) mucosal incision, and adequate submucosal dissection; (C) complete snaring resection; (D) a clear post-hybrid ESD defect.
Figure 2
Figure 2
Schematic diagrams of hybrid endoscopic submucosal dissection (ESD) for rectal neuroendocrine tumors (NET). (A) Snare was placed after adequate submucosal dissection; (B) complete snaring resection was performed for the undissected part.
Figure 3
Figure 3
Flow chart of the patients and lesions enrolled in this study. ESD, endoscopic submucosal dissection. NET, neuroendocrine tumor.
See this image and copyright information in PMC

References

    1. 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;3:1335-42. 10.1001/jamaoncol.2017.0589 - DOI - PMC - PubMed
    1. Hallet J, Law CH, Cukier M, et al. Exploring the rising incidence of neuroendocrine tumors: a population-based analysis of epidemiology, metastatic presentation, and outcomes. Cancer 2015;121:589-97. 10.1002/cncr.29099 - DOI - PubMed
    1. Fraenkel M, Kim M, Faggiano A, et al. Incidence of gastroenteropancreatic neuroendocrine tumours: a systematic review of the literature. Endocr Relat Cancer 2014;21:R153-63. 10.1530/ERC-13-0125 - DOI - PubMed
    1. de Mestier L, Brixi H, Gincul R, et al. Updating the management of patients with rectal neuroendocrine tumors. Endoscopy 2013;45:1039-46. 10.1055/s-0033-1344794 - DOI - PubMed
    1. Konishi T, Watanabe T, Kishimoto J, et al. Prognosis and risk factors of metastasis in colorectal carcinoids: results of a nationwide registry over 15 years. Gut 2007;56:863-8. 10.1136/gut.2006.109157 - DOI - PMC - PubMed