经内镜黏膜下剥离术治疗直肠神经内分泌肿瘤的疗效及安全性CSCD

目的探讨经内镜黏膜下剥离术(ESD)治疗直肠神经内分泌肿瘤(RNET)的疗效,并评估其安全性。方法回顾性分析2011年1月—2017年12月在江苏省人民医院行直肠ESD治疗、经病理及免疫组织化学确诊为RNET的80例患者(91处病变)的临床资料,并对患者进行随访。结果所有病变均为完整切除病灶。有症状的患者术后3天~2月症状均有不同程度缓解,无严重术后并发症,标本切缘阳性率20.88%(19/91),切缘可疑阳性率35.16%(32/91)。切除标本最大长径20 mm。单因素分析中,肿瘤长径≥10 mm、肿瘤处于G2级与切缘可疑阳性及阳性相关(P<0.05)。肿瘤处于G2级为切缘可疑阳性及阳性的独立危险因素。仅有1例患者术前证实为RNET。中位随访时间34月,复发率4.40%(4/91)。结论ESD在治疗直径<20 mm的G1级和G2级的RNET患者中具有良好疗效。对于ESD术后显示切缘阳性及可疑阳性的RNET患者,可密切随访暂不实施其他治疗。

Safety and Efficacy of Endoscopic Submucosal Dissection for Rectal NeuroendocrineTumor

Objective To investigate the effects of endoscopic submucosal dissection (ESD) on rectal neuroendocrine tumor(RNET) and evaluate its safety. Methods We retrospectively analyzed the clinical data of 80 patients (91 lesions) diagnosed as RNET underwent rectal ESD from January 2011 to December 2017 in Jiangsu Provincial People's Hospital. All patients were followed up. Results All lesions were completely resected. Symptomatic patients had different degrees of relief from the 3rd days to 2 months after surgery. There was no serious postoperative complication. The positive rate of margin was 20.88% (19/91). The suspicious positive rate of margin was 35.16% (32/91). The maximum long diameter of specimen was 20 mm. Tumor size ≥10mm and Grade G2 were associated with suspicious positive and positive margin in univariate analysis(P<0.05). Grade G2 was identified as independent risk factor in multivariate analysis (P<0.05). Only one patient in this study was confirmed to be RNET preoperatively. Median follow-up was 34 months and the recurrence rate was 4.40% (4/91). Conclusion ESD is effective in the treatment of G1 and G2 grades RNET patients with tumor diameter <20mm. For RNET patients with positive margin and suspicious positive margin after ESD, close follow-up without additional treatment seems to be a feasible option.