| Background and purposeRectal neuroendocrine tumors(R-NETs)grow slowly,heterogeneous tumors originating from peptidogenic neurons and neuroendocrine cells.Overall,R-NETs accounted for only 1.1%to 1.3%of all rectal-derived malignancies;R-NETs account for 50%of all gastrointestinal neuroendocrine tumors in Asian countries.The discovery and diagnosis of R-NETs is related to the development of endoscopic procedures of the colon and the improved understanding of R-NETs.R-NETs grow slowly and have a good prognosis,but they can develop lymph node metastases and distant metastases,so they are still classified as malignant tumors.In this study,we retrospectively analyzed the basic clinical data of patients with rectal neuroendocrine tumors to screen the risk factors and predictors related to pathological grade.In addition,we compare two endoscopic treatments with Endoscopic mucosal resection with a cap(EMR-C)and Endoscopic submucosal dissection were studied(ESD).This helps to diagnose R-NETs in a timely manner and provides more evidence for appropriate treatment according to different characteristics.MethodsA retrospective study was conducted on patients who underwent colonoscopy and were pathologically diagnosed with rectal neuroendocrine tumors in Nannan Hospital of Southern Medical University from January 2010 to December 2019.To analyze the clinical and pathological characteristics of patients with R-NETs,and the risk factors affecting the pathological grading of R-NETs.To compare the efficacy of EMR-C and ESD in the resection of rectal neuroendocrine tumors with the largest tumor diameter ≤10mm.ResultsA total of 254 patients(all single,no multiple lesions)with R-NETs were enrolled.There are 228 cases(89.8%)had the maximum diameter ≤10mm,and 26 cases(10.2%)had the maximum diameter>10mm.Of the 228 R-NETs with maximum diameter ≤10mm,94 underwent EMR-C resection,67 underwent ESD resection,47 underwent EMR resection,18 underwent high frequency electrocoagulation resection,and 2 underwent surgical treatment due to lymph node metastasis.Among the 254 patients,the ratio of male to female was 1.82:1,and the mean age of onset was 45.1±11.7 years.Non-specific clinical symptoms were found in 33.5%,and physical examination found in 66.5%.The median rectum was most prone to R-NETs(141/254,55.5%).The mean maximum tumor diameter was 7.31±3.62mm.Under endoscopic ultrasonography,95 cases(37.4%),146 cases(57.4%),13 cases(5.1%)were found to reach muscularis propria,muscularis propria.Synaptophysin(Syn)and pheochromogranin A(CgA)were detected and the sensitivity of Syn was significantly higher than that of CgA.The positive rates of Syn and CgA were 99.2%and 24.4%respectively.Pathological grade 215 cases(84.6%)were G1,38 cases(15.0%)G2,and 1 case(0.4%)G3.A total of 9 patients(3.5%)had lymph node metastases.There were significant differences in tumor maximum diameter,lesion depth,and lymph node metastasis among R-NETs with different pathological grades(P<0.001).There was no significant difference in gender,age,site of disease and positive rate of immunohistochemical markers(Syn,CgA)(P>0.05).Multivariate Logistic regression analysis showed that tumor maximum diameter(OR=1.220,P<0.001)and lesion depth(OR=2.453,P<0.05)were independent risk factors for pathological grade.A total of 161 patients with R-NETS whose tumor diameter was less than or equal to 10mm were treated with EMR-C and ESD,and were divided into EMR-C and ESD groups according to the treatment modems.There were no significant differences between EMR-C and ESD in age,sex,maximum tumor diameter,lesion site,or lesion depth(P>0.05).The analysis of treatment results showed that there were no differences between the two groups in postoperative mean hospital stay,lesion resection rate,block resection rate and postoperative pathological grade(P>0.05).The operation time of ESD group was significantly longer than that of EMR-C group(P<0.001),and the operation cost of ESD was significantly higher than that of EMR-C group(P<0.001).No gastrointestinal perforation and peritonitis occurred in all patients.Postoperative delayed bleeding was found in 9 patients(2 cases in EMR-C group and 7 cases in ESD group),and the risk of delayed bleeding after ESD was significantly higher than that of EMR-C,with statistical significance(P<0.05).ConclusionThe vast majority of R-NETs have no specific clinical manifestations and are most common happen in 40-60 year old men.Different pathological grades differ in tumor maximum size,lesion depth,and lymph node metastasis.Tumor size and lesion depth were independent risk factors affecting pathological grade.For R-NETs with maximum tumor diameter ≤10mm,EMR-C and ESD treatment showed no significant difference in tumor resection rate between the two groups,while EMR-C had the advantages of shorter operation time,fewer complications,and lower surgical cost. |
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