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Endoscopically removed rectal NETs: a nationwide cohort study

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International Journal of Colorectal Disease Aims and scope Submit manuscript

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.

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Author information

Authors and Affiliations

  1. Department of Gastroenterology, University Medical Centre Utrecht, Utrecht, the Netherlands

    Teaco Kuiper & F. D. Vleggaar

  2. Department of Gastroenterology, Amstelland Hospital, Laan van de Helende Meesters 8, 1186 AM, Amstelveen, the Netherlands

    Teaco Kuiper

  3. Department of Medical Oncology, Amsterdam University Medical Centre, Amsterdam, the Netherlands

    M. G. H. van Oijen & H. J. Klümpen

  4. Department of Pathology, Erasmus Medical Centre, Rotterdam, the Netherlands

    M. F. van Velthuysen

  5. Department of Gastroenterology St Antonius Medical Centre, Nieuwegein, the Netherlands

    N. van Lelyveld

  6. Department of Gastroenterology, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands

    M. E. van Leerdam

  7. Department of Gastroenterology, Leiden University Medical Centre, Leiden, the Netherlands

    M. E. van Leerdam

Authors
  1. Teaco Kuiper
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  2. M. G. H. van Oijen
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  3. M. F. van Velthuysen
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  4. N. van Lelyveld
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  5. M. E. van Leerdam
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  6. F. D. Vleggaar
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  7. H. J. Klümpen
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Contributions

T Kuiper: Study concept and design; acquisition of data; analysis and interpretation of data; statistical analysis; drafting of the manuscript

M G H van Oijen: Study concept and design; analysis and interpretation of data; statistical analysis; critical revision of the manuscript

M F van Velthuysen: Analysis and interpretation of data; critical revision of the manuscript

N van Lelyveld: Critical revision of the manuscript

M E van Leerdam: Analysis and interpretation of data; critical revision of the manuscript

F D Vleggaar: Critical revision of the manuscript

H J Klümpen: Study concept and design; critical revision of the manuscript

Corresponding author

Correspondence to Teaco Kuiper.

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Kuiper, T., van Oijen, M.G.H., van Velthuysen, M.F. et al. Endoscopically removed rectal NETs: a nationwide cohort study. Int J Colorectal Dis 36, 535–541 (2021). https://doi.org/10.1007/s00384-020-03801-w

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  • DOI: https://doi.org/10.1007/s00384-020-03801-w

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