A comparative study on endoscopic and surgical treatment of small rectal neuroendocrinal tumor

Abstract

Objective To compare the differences between endoscopic resection and laparoscopy-assisted surgery or transanal endoscopic resection for rectal neuroendocrinal tumor. Methods Clinical data of patients who underwent endoscopic or surgical resection of neuroendocrinal tumor of less than 2 cm which were confirmed by pathology from December 2010 to November 2013 were retrospectively analyzed. Results Twenty cases of endoscopic treatment, including 17 cases of ESD, 3 cases of EMR, were included in endoscopy group; while 18 cases treated with surgery were included in surgery group, among which 12 cases underwent transanal endoscopic microsurgery and 6 cases laparoscopic resection. The mean lesion sizes were 7 mm(4-18 mm)and 8 mm(3-15 mm), respectively. Pathology showed there were 16 cases of grade G1 neurocrinal tumor and 2 G2 cases in surgical group. There was no lymphvascular invasion with clear margin in the endoscopy group, but three cases of lymphvascular invasion in surgical group. No treatment-related severe adverse event occurred in either group. The time for oral food intake was 2.0 d(1-4 d) in endoscopy group, while that in surgery group was 2.4 d(1-7 d)(P=0.295). The hospital stay was(6.80±2.12) d in endoscopy group and(8.59±2.85)d in surgery group, respectively(P=0.034). And the total hospitalization cost was 10 488(4 128-15 296) yuan and 15 590(3 024-40 503) yuan(P=0.031) in the two groups, respectively. The follow-up was 25 months(2-48 months)and no recurrence was found. Conclusion Endoscopic resection, especially ESD, is a new approach to treat colorectal neuroendocrinal tumor, advantageous over surgery in shorter hospitalization time, minimal invasiveness, faster postoperative recovery, less complication, and reduced hospitalization cost. Key words: Rectum; Neuroendocrine tumors; Laparoscopes; Surgical procedures, operative; Endoscopic submucosal dissection