Clinicopathological Features,Comparative Analysis Of Endoscopic And Surgical Treatment And Factors For Lymph Node Metastasis Of Rectal Neuroendocrinal Tumor

PART ⅠClinicopathological Features of Patients with Rectal Neuroendocrinal TumorBackground and objectiveIn recent years,the reports of rectal neuroendocrine tumor have gradually increased,but there is still a lack of the study of its clinicopathological features in China.Materials and methodsIn this study,161 cases with rectal neuroendocrine tumor were collected from the First Affiliated Hospital of Zhengzhou University from January 2011 to December 2017.Retrospective analysis of the clinical manifestations,medical history,serological examination,endoscopic examination,pathological features,treatment and prognosis.The data of the cases with rectum neuroendocrine tumor were analyzed by frequency or percentage.ResultsAmong 161 cases with rectal neuroendocrine tumor,there were 108 male cases,53 female cases.The main clinical symptoms included hematochezia,abdominal pain and altered bowel habits.The most common past history were history of smoking,history of drinking,and history of malignant tumor.The number of patients diagnosed as rectal neuroendocrine neoplasms were increasing year by year.Endoscopic examination showed protruding type,and most rectal NENs were located within<10cm from the anus.96 cases were given endoscopic treatment,including ESD and EMR.Endoscopic ultrasonography showed that rectal neuroendocrine tumors arose from the submucosa.98.14%of the patients were homogeneous hypoechoic.The diameter of the tumors in most patients was less than<2cm.The pathological grade G1 was the most common(67.09%).Local and distant metastasis could be found.Conclusions1.There were more males than females in rectal neuroendocrine tumors.2.The clinical manifetatian mainly includes blood stool,abdominal pain and altered bowel habits.3.Rectal neuroendocrine tumors were characterized by protruding,most patients located at the rectum<10cm from the anal margin,and the resection rates of EMR and ESD are similar.4.The most common pathological grade is G1 in patients with rectal neuroendocrine neoplasms.5.Endoscopic ultrasonography revealed that rectal neuroendocrine neoplasms mostly arose from submucosa,and the echo was homogeneous and hypoechoic.PART ⅡComparative Analysis of Endoscopic and Surgical Treatment for Patients with Rectal Neuroendocrinal Tumor less than 2cmBackground and objectiveThe treatment ways of rectal neuroendocrine tumors are not uniform,the previous treatment is mainly by surgery or laparoscopic assisted transanal resection.With increasing use of digestive endoscopy in recent years,such as EMR,ESD etc.,it can be applied in patients with small rectal neuroendocrine tumors(diameter<2cm).The purpose of this study is to compare the efficacy,safety and economics of endoscopic and surgical treatment.Materials and methodsThis study is a retrospective study.We collected the clinical data of patients with rectal neuroendocrine tumor from the First Affiliated Hospital of Zhengzhou University between January 1,2011 to December 31,2017.There were 105 patients with neuroendocrine tumors with diameter<2cm,of which 60 were treated by endoscopy,and 45 were treated by surgery.The patients were followed up in 1,3,6 and 12mo after treatment.Colonoscopy,bone scan and CT were performed to find out whether there was any residual or recurrence of the lesion.ResultsThere was no significant difference in baseline characteristics between the endoscopic treatment group and the surgical group.The operative time(from submucosal injection to complete exfoliation lesion)in endoscopic treatment group was 23min(9-45min),which was better than that in surgical group,in which 53min(25-320min)(P=0.025).The amount of bleeding in endoscopic treatment group was 5ml(2-45ml),which was less than that in surgical group(130ml(15-550ml))(P=0.004).The postoperative complications in endoscopic treatment group were less than those of the surgical group(P=0.018).The time of hospitalization in the endoscopic treatment group was shorter than that of the surgical group,and the cost of hospitalization was less than that of the surgical group(P<0.05).No clear recurrence and metastasis were found during the follow-up.ConclusionsFor patients with small rectal neuroendocrine tumor,endoscopic ESD is a new choice of treatment,similar to surgical resection,but with advantages such as less operation trauma,shorter operation time,less operation bleeding,fewer postoperative complications,shorter hospitalization stay and less cost.PART ⅢRisk Factors for Lymph Node metastasis and Prognostic Factors for Rectal Neuroendocrinal TumorBackground and objectivePrevious studies have shown that many factors are associated with lymph node metastasis and poor prognosis of rectal neuroendocrine tumors.However,the sample was small.This paper aims to explore the risk factors associated with lymph node metastasis and prognosis of rectal neuroendocrine tumors by a relative larger sample in China.Materials and methodsA total of 161 patients with pathologically confirmed rectal neuroendocrine tumors were included in this study,including 37 cases with lymph node metastasis and 124 cases without lymph node metastasis after imaging or postoperative pathology.The patients were followed up in 1,3,6 and 12mo after treatment.Colonoscopy,bone scan and CT were performed to understand the progression and recurrence of the disease.ResultsSmoking history,drinking history,malignant tumor history,tumor size,lymphatic vessel invasion,microvascular invasion and pathological grading were all risk factors associated with lymph node metastasis in rectal neuroendocrine tumors(P<0.05).The history of diabetes and the history of hypertension were not related to the lymph node metastasis of the disease(P>0.05).Multiple factors regression analysis model adjusted possible factors(such as follow-up time).The results showed that smoking history,drinking history,malignant tumor history,tumor volume and pathological grades were independently correlated with lymph node metastasis(P<0.05).Further studies showed that lymph node metastasis was significantly related to the prognosis.the prognosis of patients without smoking history and drinking history and the history of malignant tumor(P<0.05),pathological grade G1 prognosis was better than that of G2 and G3(P<0.05)ConclusionsAt the time of diagnosis of rectal neuroendocrine tumor,tumor grade,tumor size,smoking history,drinking history,history of malignancy of and lymph node metastasis independently associated with lymph node metastasis.moreover,lymph node metastasis,smoking history,drinking history and the history of malignancy can influence the prognosis of patients with rectal neuroendocrine tumor.