Endoscopic full thickness resection vs. transanal endoscopic microsurgery for local treatment of rectal neuroendocrine t
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ORIGINAL ARTICLE
Endoscopic full thickness resection vs. transanal endoscopic microsurgery for local treatment of rectal neuroendocrine tumors - a retrospective analysis Markus Brand 1 & Stanislaus Reimer 1 & Joachim Reibetanz 2 & Sven Flemming 2 & Marko Kornmann 3 & Alexander Meining 1 Accepted: 10 November 2020 # The Author(s) 2020
Abstract Purpose Local treatment of small well-differentiated rectal neuroendocrine tumors (NETs) is recommended by current guidelines. However, although several endoscopic methods have been established, the highest R0 rate is achieved by transanal endoscopic microsurgery (TEM). Since a recently published study about endoscopic full thickness resection (eFTR) showed a R0 resection rate of 100%, the aim of this study was to evaluate both methods (eFTR vs. TEM). Methods We retrospectively analyzed all patients with rectal NET treated either by TEM (1999–2018) or eFTR (2016–2019) in two tertiary centers (University Hospital Wuerzburg and Ulm). We analyzed clinical, procedural, and histopathological outcomes in both groups. Results Twenty-eight patients with rectal NET received local treatment (TEM: 13; eFTR: 15). Most tumors were at stage T1a and grade G1 or G2 (in the TEM group two G3 NETs were staged T2 after neoadjuvant chemotherapy). In both groups, similar outcomes for en bloc resection rate, R0 resection rate, tumor size, or specimen size were found. No procedural adverse events were noted. Mean procedure time in the TEM group was 48.9 min and 19.2 min in the eFTR group. Conclusion eFTR is a convincing method for local treatment of small rectal NETs combining high safety and efficacy with short interventional time. Keywords Rectum . Neuroendocrine tumor (NET) . Transanal endoscopic microsurgery (TEM) . Endoscopic full thickness resection (eFTR) . Full-thickness resection device (FTRD)
Introduction Well differentiated neuroendocrine tumors (NETs) of the rectum are rare and often present as asymptomatic incidental findings during colonoscopy [1]. However, due to higher participation rates of patients to screening colonoscopies, these submucosal
* Markus Brand [email protected] 1
Medical Department II, Gastroenterology, University Hospital Wuerzburg, Oberduerrbacher Str. 6, Wuerzburg 97080, Germany
2
Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
3
Department of General and Visceral Surgery, University Hospital Ulm, Ulm, Germany
tumors are diagnosed more frequently [2, 3]. Most of those tumors are less than 10 mm in diameter and typically present as a small yellowish submucosal nodule often overlaid by a normal mucosal surface. Small rectal NETs (≤ 10 mm) present a low incidence of lymphovascular invasion and accordingly of metastasis. Thus, the current European Neuroendocrine Tumor Society (ENETS) guidelines recommend local treatment for G1/G2 rectal NETs below 10 mm in stage T1 and T2 and for G1/G2 rectal NET between 10 and 20 mm in stage T1 without lymph node metastasis (LNM) [1]. Radical sur
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