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Review
. 2022 Mar 21;28(11):1123-1138.
doi: 10.3748/wjg.v28.i11.1123.

Rectal neuroendocrine tumors: Current advances in management, treatment, and surveillance

Camilla Gallo  1 , Roberta Elisa Rossi  2 , Federica Cavalcoli  3 , Federico Barbaro  4 , Ivo Boškoski  4 , Pietro Invernizzi  1 , Sara Massironi  5
Affiliations
Review

Rectal neuroendocrine tumors: Current advances in management, treatment, and surveillance

Camilla Gallo et al. World J Gastroenterol. .

Abstract

Rectal neuroendocrine neoplasms (r-NENs) are considered among the most frequent digestive NENs, together with small bowel NENs. Their incidence has increased over the past few years, and this is probably due to the widespread use of endoscopic screening for colorectal cancer and the advanced endoscopic procedures available nowadays. According to the current European Neuroendocrine Tumor Society (ENETS) guidelines, well-differentiated r-NENs smaller than 10 mm should be endoscopically removed in view of their low risk of local and distant invasion. R-NENs larger than 20 mm are candidates for surgical resection because of their high risk of distant spreading and the involvement of the muscularis propria. There is an area of uncertainty regarding tumors between 10 and 20 mm, in which the metastatic risk is intermediate and the endoscopic treatment can be challenging. Once removed, the indications for surveillance are scarce and poorly codified by international guidelines, therefore in this paper, a possible algorithm is proposed.

Keywords: Endoscopic submucosal dissection; Endoscopy; Rectal neuroendocrine tumors; Resectable advanced disease; Systemic therapy.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflict of interests for this article.

Figures

Figure 1
Figure 1
Endoscopic aspect of a rectal neuroendocrine neoplasm.
Figure 2
Figure 2
Endoscopic ultrasound aspect of a rectal neuroendocrine neoplasm.
Figure 3
Figure 3
Endoscopic submucosal dissection of a rectal neuroendocrine neoplasm. A: Rectal neuroendocrine neoplasm aspect before the procedure; B: Initial submucosal dissection beneath the lesion; C: Almost completed submucosal dissection beneath the lesion; D: Final aspect of the endoscopic submucosal dissection eschar.
Figure 4
Figure 4
The full thickness resection device Ovesco over-the-scope OTSC system is a single-use metallic clip preloaded on an applicator cap that can be attached to any standard endoscope. The endoscopic clip can be placed underneath an epithelial/subepithelial lesion and it guarantees at the same time its full-thickness removal and the wall defect closure. In this picture, the Ovesco clip is placed underneath a rectal neuroendocrine neoplasm and grabs its complete thickness.
Figure 5
Figure 5
Surveillance flow-chart. CT: Computed tomography; MRI: Magnetic resonance imaging; US: Ultrasound; SRI: Somatostatin receptor imaging; FDG-PET: Positron emission tomography with 18F-fluorodeoxyglucose.
See this image and copyright information in PMC

References

    1. Dasari A, Shen C, Halperin D, Zhao B, Zhou S, Xu Y, Shih T, Yao JC. Trends in the Incidence, Prevalence, and Survival Outcomes in Patients With Neuroendocrine Tumors in the United States. JAMA Oncol. 2017;3:1335–1342. - PMC - PubMed
    1. Wang XY, Chai NL, Linghu EQ, Li HK, Zhai YQ, Feng XX, Zhang WG, Zou JL, Li LS, Xiang JY. 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. Ann Transl Med. 2020;8:368. - PMC - PubMed
    1. Osagiede O, Habermann E, Day C, Gabriel E, Merchea A, Lemini R, Jabbal IS, Colibaseanu DT. Factors associated with worse outcomes for colorectal neuroendocrine tumors in radical versus local resections. J Gastrointest Oncol. 2020;11:836–846. - PMC - PubMed
    1. Ploeckinger U, Kloeppel G, Wiedenmann B, Lohmann R representatives of 21 German NET Centers. The German NET-registry: an audit on the diagnosis and therapy of neuroendocrine tumors. Neuroendocrinology. 2009;90:349–363. - PubMed
    1. Chang JS, Chen LT, Shan YS, Chu PY, Tsai CR, Tsai HJ. An updated analysis of the epidemiologic trends of neuroendocrine tumors in Taiwan. Sci Rep. 2021;11:7881. - PMC - PubMed