| Objective:To investigate the clinicopathological characteristics of rectal neuroendocrine neoplasms(R-NENs)and compare the clinical efficacy and safety of endoscopic submucosal dissection(ESD)with surgical local resection for T1 R-NENs.Methods:To collect clinical data of patients who were diagnosed as T1 R-NENs in the First Hospital of Jilin University from March 2012 to April 2020 for retrospective analysis.There were 185 cases in total.According to treatment methods,they were divided into endoscopic group(n=104)and surgical group(n=81).The clinical baseline data,resection related status,surgery and hospitalization related indicators and follow-up data of the two groups were compared and analyzed.Results:1.General information: 111 males(60%)and 74 females(40%)of the 185 patients were aged(50.8±10.4)years(23-79 years);the clinical manifestations of R-NENs were not specificity,the main symptoms included changes in bowel habits or traits(58 cases,31.4%),abdominal discomfort(26 cases,14.1%),hematochezia(12 cases,6.5%),anal discomfort(2 cases,1.1%),87 cases(47.0%)of patients were found during routine physical examination.2.Endoscopic information: A total of 202 lesions were detected in 185 patients,and 175 cases(94.6%)with a single tumor;193(95.5%)tumors were located in the middle and lower rectum,and 158(78.2%)were infiltrated in the submucosa layers;Colonoscopy showed flat or hemispherical prominence,smooth surface mucosa,rare cases with ulcers/depressed(19 cases,9.4%),tumor diameter(7.7±3.5)mm(3-20mm);126 cases(145 lesions)underwent preoperative endoscopic ultrasonography(EUS)examination,91.7%(133 lesions)were hypoechoic lesions.140 cases were diagnosed as R-NENs by EUS before operation,the diagnostic coincidence rate with the postoperative pathological results reached 96.6%(140/145).3.Pathology and immunohistochemistry : Lesions with grade G1 and grade G2 accounted for 93.6%(189/202)and 6.4%(13/202)respectively.The results of immunohistochemistry indicated that the positive rates of Syn,Cg A and CD56 were98.9%(184/186)、36.6%(63/172)and 95.6%(173/181),respectively.4.Intraoperative and postoperative conditions of the two groups: 104 patients(56.2%)received ESD surgery,81 patients(43.8%)received surgical local resection,and the baseline characteristics of the two groups is no statistical significance(all P>0.05).The en bloc resection rate in both groups was 100%.The R0 resection rate and curative dissection rate were 82.5% and 57.9% in endoscopic group,89.8% and60.2% in surgical group,there were no significant difference between the two groups(P > 0.05);Compared with the surgical group,the endoscopic group had significantly shorter operation time [23min(15,30 min)vs 53 min(40,85 min),P<0.001],the complication rate was lower(2.9% vs 11.1%,P=0.024),and the hospitalization expenses were significantly reduced(19682.1±5630.8yuan vs22439.7±11000.7 yuan,P=0.042).5.Follow-up: The median follow-up time was 31 months,and the average follow-up time was 36.1±20.3 months.Local recurrence occurred in 1 patient(0.54%,1/185).The recurrence time was the 17 th months after ESD.Conclusion:1.R-NENs are more common in middle-aged and elderly men,which are more common in the middle and lower rectum,and the clinical manifestations are not specific.2.ESD is safe and effective method in the treatment of T1 R-NENs,without lymph nodes and distal metastasis,and pathological grade of G1 or G2.Compared with surgical local resection,it has less trauma and operation time,fewer complications,and lower hospitalization costs.3.For patients with positive/indeterminate margins after ESD,close follow-up is required. |
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