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Long-term clinical outcomes of endoscopic submucosal dissection in rectal neuroendocrine tumors based on resection margin status: a real-world study

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Abstract

Background

Endoscopic submucosal dissection (ESD) has been widely adopted in treating rectal neuroendocrine tumors (NETs). However, clinical outcomes in rectal NETs after ESD with different resection margin status remain scanty, particularly in patients with positive resection margins. This study aimed to evaluate the long-term clinical outcomes of ESD in rectal NET based on the resection margin status.

Methods

This retrospective study included 436 patients diagnosed with rectal NET who had undergone ESD. Clinical data, including age, sex, tumor size, stage, invasion, and the resection margin status, were collected. Further, the patients were assessed for complications, recurrence, distant metastasis, and long-term outcomes.

Results

Among all 436 patients, 395 patients had their primary ESD in our hospital. Complete resection was achieved in 319 patients. Patients who did not achieve complete resection opted for follow-up (n = 73), salvage surgery (n = 1) and salvage ESD (n = 2). Another 41 had their primary ESD in other hospital with incomplete resection and had salvage ESD in our hospital. All 436 patients had a median follow-up period of 61.4 months (range 33.4–125.3 months). During the follow-up period, two patients developed recurrences, while three patients developed metastasis. There were no significant differences in the 5-year progression-free survival and overall survival between patients with incomplete resection opting for follow-up compared to the other two groups (P = 0.5/0.8). However, the complication rates were significantly higher in patients who received salvage ESD.

Conclusion

This study demonstrated that positive resection margins have no influence on survival in patients with rectal NET treated using ESD.

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Funding

This work was supported by the National Key R&D Program of China (No.2019YFC1315800/2019YFC1315802), National Natural Science Foundation of China (No. 81902394, 82002515, 81502000), Shanghai Sailing Program (No.20YF1407200), China Postdoctoral Science Foundation (No. 2020M681177), and Shanghai Municipal Commission of Science and Technology (NO. 19140901902, 18DZ1930302, 22S31903800).

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Author notes

  1. Di Sun, Zhong Ren and Enpan Xu have contributed equally to this paper.

Authors and Affiliations

  1. Endoscopy Center, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China

    Di Sun, Zhong Ren, Enpan Xu, Shilun Cai, Zhipeng Qi, Zhanghan Chen, Jingyi Liu, Qiang Shi, Pinghong Zhou & Yunshi Zhong

  2. Endoscopy Research Institute of Fudan University, 180 Fenglin Road, Shanghai, 200032, China

    Di Sun, Zhong Ren, Enpan Xu, Shilun Cai, Zhipeng Qi, Zhanghan Chen, Jingyi Liu, Qiang Shi, Pinghong Zhou & Yunshi Zhong

  3. Department of Breast Diseases, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

    Di Sun

  4. Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China

    Di Sun

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  1. Di Sun
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Correspondence to Qiang Shi, Pinghong Zhou or Yunshi Zhong.

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Disclosure

Drs. Di Sun, Zhong Ren, Enpan Xu, Shilun Cai, Zhipeng Qi, Zhanghan Chen, Jingyi Liu, Qiang Shi, Pinghong Zhou, Yunshi Zhong have no conflicts of interest or financial ties to disclose.

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Sun, D., Ren, Z., Xu, E. et al. Long-term clinical outcomes of endoscopic submucosal dissection in rectal neuroendocrine tumors based on resection margin status: a real-world study. Surg Endosc 37, 2644–2652 (2023). https://doi.org/10.1007/s00464-022-09710-z

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