Endoscopic treatment of rectal neuroendocrine tumors in a 13-year retrospective single-center study. Are we following the guidelines?

Abstract

Rectal neuroendocrine tumors (rNETs) are potentially metastatic lesions.False endoscopic diagnosis and subsequent treatment may lead to non-radical resection and metastases. To investigate the clinical characteristics of rNETs, check whether the lesion origin was suspected by endoscopists on examination, and if these lesions were subsequently removed by use of the appropriate method, and analyze the fates of patients after curative and non-curative resections. We analyzed the records of patients hospitalized in our department (2006-2019) with a diagnosis of rNET. We included 40 patients with rNET. We evaluated the clinical characteristics, and whether the neuroendocrine origin of the lesions was suspected on endoscopy. We compared patient outcomes in those treated by the proper method (ESD/EMR) with those treated by polypectomy. Lesions appeared as typical yellowish subepithelial lesions (n = 24), resembling hyperplastic polyps (n = 12), or tumors with central depression (n = 4). The median size was 5,5 mm, and most were G1 lesions (n = 36). Only 14 of them were suspected to be of neuroendocrine origin at first endoscopy, and 12 were removed by ESD/EMR. The rest of the tumors (n = 26) were removed using polypectomy. Most of the patients were disease-free at follow-up, but two patients after polypectomy, and one patient after non-radical ESD, developed metastases. In most cases, the origin of the lesion was not suspected on colonoscopy, and subsequently the tumor was removed by an inappropriate method. Endoscopists do not follow the guidelines when dealing with patients with rNETs and more emphasis must be placed on education regarding management with rNETs.