Long-term prognosis of an endoscopically treated rectal neuroendocrine tumor:  10-year experience in a single institution.
OBJECTIVE
The endoscopic techniques for treating a small rectal neuroendocrine tumor (NET) are performed in most large centers; however, the endoscopic management of this condition is not well established. This study was designed to determine the long-term prognosis of endoscopically resected NET.


METHODS
We prospectively studied patients with endoscopically treated rectal NET in Seoul St Mary's hospital, between January 2000 and June 2010. The long-term outcomes were analyzed in association with the pathological complete resection and resection procedures.


RESULTS
Seventy-seven patients (48 men and 29 women; mean age, 52.3 years; range, 23-77 years) were included. The average NET size was 7.0±2.8 mm (range, 3-16 mm). There was no procedure-related complication. En-bloc removal was achieved for all lesions, and the rate of histological complete resection was 75.3% (58/77). Histological complete resection rates were 71.4% (10/14) by conventional endoscopic mucosal resection (EMR), 74.1% (43/58) by a two-channel EMR, and 100.0% (5/5) by endoscopic submucosal dissection (ESD). Among six patients with incomplete histological resection, two underwent additional EMR, two underwent transanal endoscopic microsurgery, and two underwent low anterior section with lymph node dissection. The remaining 13 patients with 'possible' remnant NET underwent regular endoscopic surveillance without additional resection. In the latter group, only one patient had local recurrence, detected on regular colonoscopic surveillance, after 56 months and was treated with additional EMR. All of the patients are alive and 98.7% (76/77) of the patients are free from disease during the follow-up periods.


CONCLUSIONS
Endoscopic resection is a safe and effective modality and may potentially be used for the treatment of NETs smaller than 15 mm in diameter, those confined to the submucosal layer, and those without metastasis. Local treatment was believed to be curative in cases with complete histological resection. In addition, this treatment may have an excellent prognosis in patients with 'possible' remnant NET.
Department of Internal Medicine, Division of Gastroenterology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Hye Young
HY
Sung
Sang Woo
SW
Kim
Won Kyung
WK
Kang
Su Young
SY
Kim
Chan-Kwon
CK
Jung
Yu Kyung
YK
Cho
Jae Myung
JM
Park
In Seok
IS
Lee
Myung-Gyu
MG
Choi
In-Sik
IS
Chung
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000601:surgery*; D011351:Proctoscopy / Q000009:adverse effects / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult