Endoscopically removed rectal NETs: a nationwide cohort study
- PDF / 447,538 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 23 Downloads / 185 Views
ORIGINAL ARTICLE
Endoscopically removed rectal NETs: a nationwide cohort study Teaco Kuiper 1,2 & M. G. H. van Oijen 3 & M. F. van Velthuysen 4 & N. van Lelyveld 5 & M. E. van Leerdam 6,7 & F. D. Vleggaar 1 & H. J. Klümpen 3 Accepted: 10 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Rectal neuroendocrine tumours (NETs) often present as an incidental finding during colonoscopy. Complete endoscopic resection of low-grade NETs up to 10 mm is considered safe. Whether this is also safe for NETs up to 20 mm is unclear. We performed a nationwide study to determine the risk of lymph node and distant metastases in endoscopically removed NETs. Methods All endoscopically removed rectal NETs between 1990 and 2010 were identified using the national pathology database (PALGA). Each NET was stratified according to size, grade and resection margin. Follow-up was until February 2016. Results Between 1990 and 2010, a total of 310 NETs smaller than 20 mm were endoscopically removed. Mean size of NETs was 7.4 mm (SD 3.5). In 49% of NETs (n = 153), no grade (G) could be assessed from the pathology report, 1% was G2 (n = 3), and the remaining NETs were G1. Median follow up was 11.6 years (range 4.9–26.0). During follow-up, 30 patients underwent surgical resection. Lymph node or distant metastasis was seen in 3 patients (1%) which all had a grade 2 NET. Mean time from endoscopic resection to diagnosis of metastases was 6.1 years (95% CI 2.9–9.2). Conclusion No lymph node or distant metastases were seen in endoscopically removed G1 NETs up to 20 mm during the long follow-up of this nationwide study. This adds evidence to the ENET guideline that endoscopic resection of G1 NETs up to 20 mm appears to be safe. Keywords Rectum . Neuroendocrine tumour . Endoscopic resection . Recurrence
Introduction
* Teaco Kuiper [email protected] 1
Department of Gastroenterology, University Medical Centre Utrecht, Utrecht, the Netherlands
2
Department of Gastroenterology, Amstelland Hospital, Laan van de Helende Meesters 8, 1186 AM Amstelveen, the Netherlands
3
Department of Medical Oncology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
4
Department of Pathology, Erasmus Medical Centre, Rotterdam, the Netherlands
5
Department of Gastroenterology St Antonius Medical Centre, Nieuwegein, the Netherlands
6
Department of Gastroenterology, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
7
Department of Gastroenterology, Leiden University Medical Centre, Leiden, the Netherlands
The increase in incidence of rectal neuroendocrine tumours (NETs) over the last decades is thought to be a consequence of the widespread use of screening endoscopy and improved diagnosis [1–4]. Nonetheless, rectal NETs remain rare, with an estimated incidence of 0.17% [5]. Consequently, many endoscopists will encounter a negligible number of NETs over the course of a career, hindering endoscopic recognition. In addition, rectal NETs often lack distinct endoscopic features, and many are therefore exci
Data Loading...
