Safety And Effectiveness Of Endoscopic Submucosal Dissection In The Treatment Of Rectal Neuroendocrine Neoplasms

Objective:The purpose of this study is to compare the safety,effectiveness and economics of endoscopic submucosal dissection(ESD)and surgical treatment of rectal neuroendocrine neoplasmas,and to explore the safety and effectiveness of ESD in the treatment of rectal neuroendocrine neoplasmas.To provide suggestions for the choice of resection methods of rectal neuroendocrine neoplasmas.Methods:This study collected the clinical,endoscopic,endoscopic ultrasonography and pathological data of 117 patients with rectal neuroendocrine neoplasmas were treated by ESD or trans anorectal mass resection who were admitted to the second hospital of Jilin University from January 2012 to October 2018.Among them,69 cases were treated by ESD and 48 cases by surgery.The patients were reexamined by colonoscopy,abdominal CT and followed up by telephone to find out whether the lesions remained or recurred.We analyzed and summarized the case data of all patients,and used SPSS 23.0 statistical software to analyze the collected data.,P <0.05,which was statistically significant.Results:1.Gender and age: among 117 patients with rectal neuroendocrine neoplasmas,78 cases(66.7%)were male and 39 cases(33.3%)were female,The ratio was 2:1.The average age of onset was(49.6 ± 12.0)years,the minimum age was 21 years,and the maximum age was 72 years 2.Clinical symptoms:About half of the patients hadno obvious clinical symptoms(59 cases,50.4%),most of the patients with clinical symptoms were lack of specificity,such as changes in defecation habits,abdominal pain,abdominal distention,hematochezia,etc.3.Colonoscopy and endoscopic ultrasonography:Under colonoscopy,the rectum neuroendocrine neoplasmas were all mucosal upheaval,with smooth surface(112 cases,95.7%)and yellowish mucosa(101 cases,86.3%).Rectal neuroendocrine neoplasmas were more common in the middle and lower rectum(110 cases,94.0%).The average diameter of the tumors was(7.6 ± 3.7)mm,with the minimum diameter of 2 mm and the maximum diameter of15 mm.Endoscopic ultrasonography showed that most of the tumors originated from submucosa(101 cases,86.3%),with low echo(115 cases,98.2%),and homogeneous echo(97 cases,82.9%).4.Intraoperative and postoperative comparison between the two groups: There was no statistical difference between the two groups in the analysis of baseline clinical characteristics,so the next comparative study can be carried out.The average operation time of ESD group was(38.3 ± 16.6)min,which was shorter than that of the surgical group(56.3 ± 33.8)min(P<0.001);The average postoperative hospitalization time of ESD group was(4.8 ± 1.6)days,shorter than that of surgical group(5.8 ± 3.1)days(P=0.041);The hospitalization cost of ESD group was 10830(6079-27308)yuan,which was less than 15233(9104-44731)yuan of surgical operation group(P<0.001);The R0 resection rate was 94.2% in ESD group and 100.0% in surgical group,There was no significant difference in R0 resection rate between the two groups(P>0.05).There were no postoperative complications such as delayed bleeding,perforation,incision infection and abdominal infection in both groups.5.Pathology and immunohistochemistry: In pathological grade,114 cases(97.4%)were in grade G1,3 cases(2.6%)were in grade G2,and 0cases(0%)was in grade G3.Immunohistochemistry: CgA,syn and CD56 have high specificity for neuroendocrine neoplasmas,with positive expression of 68.4%,94.9%and 94.9% respectively.6.Follow up: The follow-up time was 31 months(12-88months),and there were no deaths at the last follow-up.All patients were reexamined colonoscopy and abdominal CT,no tumor recurrence and metastasis.Conclusion:1.ESD is a safe,effective and suitable treatment for clinical use in patients with rectal neuroendocrine neoplasmas with maximum tumor diameter ? 15 mm and without peripheral vascular lymph node metastasis or distant metastasis;2.In the surgical treatment of rectal neuroendocrine neoplasmas,ESD has the following advantages compared with trans anorectal tumor resection: shorter operation time,shorter postoperative hospital stays and less hospitalization cost;ESD can treat the lesions located in the upper rectum;3.In rectal neuroendocrine neoplasms,the incidence rate of male patients is higher than that of females;Rectal neuroendocrine neoplasms are more likely to occur in the middle and lower rectum;Under endoscopic ultrasonography,most of the rectal neuroendocrine neoplasmas are originated from the submucosa,which are hypoechoic and homogeneous;The pathological types of rectal neuroendocrine neoplasms are mostly G1 grade.