Recurrence and Survival of Neuroendocrine Neoplasms of the Rectum: Single-Center Experience
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ORIGINAL ARTICLE
Recurrence and Survival of Neuroendocrine Neoplasms of the Rectum: Single-Center Experience Alessandra Storino 1,2 & Daniel Wong 1 & Ana Sofia Ore 1 & Israel A. Gaytan-Fuentes 1 & Anne Fabrizio 1 & Thomas Cataldo 1 & Evangelos Messaris 1 Received: 3 September 2020 / Accepted: 30 October 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background In 2010, the World Health Organization proposed that rectal neuroendocrine neoplasms (NENs) be considered malignant. We hypothesized that patients with small, low-grade, locally excised tumors have a low risk of recurrence and death. Methods Retrospective review of institutional database 2006–2017 including consecutive adults with newly diagnosed rectum NENs. Outcome measures included risk of recurrence and 5-year overall survival. Results A total of 122 patients were diagnosed with rectal NENs. Most patients were asymptomatic and diagnosed during screening colonoscopy (80, 66.1%), had small tumors (median 0.6 cm, IQR 0.5–1) with intact muscularis propria on EUS (62/65, 95.4%), and were low grade (2017 WHO grades 1–2, n = 116, 95.1%). Lymph node and distant metastasis were found in 4 (3.3%) and 4 (3.3%) of patients, respectively. Patients were treated with local excision in 93.4% of cases with polypectomy (52, 42.6%), endoscopic mucosal resection (48, 39.3%), and transanal excision (14, 11.5%). Three patients (2.5%) required abdominoperineal resection or low anterior resection, and five patients (4.1%) received adjuvant chemotherapy. Of 87 patients surveilled, 4 (4.6%) recurred at a median time of 1 year (IQR 0.6–8). Death from neuroendocrine neoplasms occurred in 5 (4.1%) patients, all with lymph node (1/4) or metastatic disease (4/5) on presentation. Median time to death from NEN was 0.8 years (0.7–2.4). Overall 5-year survival for patients with localized disease was 98.2% (95% CI 93–99.5, Fig. 1). Conclusion Patients with small, low grade rectal NENs treated with local excision have excellent oncologic outcomes. Keywords Rectal neoplasms . Neuroendocrine carcinoma . Neuroendocrine tumors . Endoscopic mucosal resection . Transanal endoscopic surgery
1 Introduction Neuroendocrine neoplasms (NENs) include low-grade neuroendocrine tumors (NET) and high-grade neuroendocrine carcinomas (NEC). We hypothesized that most rectal NENs
Presentations This study was presented in 2020 ASCRS as a Podium Original Contribution (June 2020). * Alessandra Storino [email protected] 1
Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
2
Division of Colon and Rectal Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Gryzmish Building, 6th Floor, Boston,, MA 02215, USA
(rNENs) are indolent and can be treated with local excision with excellent oncologic outcomes.
Methods The IRB approved the review of all patients diagnosed with rENs (2006–2016). Outcomes were overall survival (OS) and recurrence. The World Health Organization 2017 system and A
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