Long-term outcomes of transanal endoscopic microsurgery for the treatment of rectal neuroendocrine tumors

Wei-Kun Shi,Yun-Hao Li,Xiao-Yuan Qiu,Jiao-Lin Zhou,Yi Xiao,Rui Hou,Guo-Le Lin,Bin Wu,Yu-Xin Liu

doi:10.1186/s12893-022-01494-2

Abstract

BackgroundTransanal endoscopic microsurgery (TEM) has been accepted worldwide for the treatment of local rectal lesions. We aimed to assess the efficacy and safety of TEM in the treatment of rectal neuroendocrine tumors (RNET).MethodsA retrospective study of patients who had undergone TEM for RNET at our institution between December 2006 and June 2019 was performed. Demographic and tumor characteristics, operative and pathological details, complications, anal function questionnaires, and follow-up data were included.ResultsA total of 144 patients was included. TEM was performed as primary excision in 54 patients, after endoscopic forceps biopsy in 57 patients, and after incomplete resection by endoscopic excision in 33 patients. The median size of all primary tumors was 0.6 cm (range, 0.3–2.0 cm), and the negative resection margin was achieved in 142 (98.6%) patients. Postoperative complications (referring to only bleeding) occurred in 3 (2.1%) patients and was successfully managed with conservative method. After a median follow-up of 75.5 months after surgery, 3 patients died of other causes, and 2 patients suffered metastasis. An anal function questionnaire was posted 24 months after TEM. Among the results, 3 (2.1%) patients complained of major low anterior resection syndrome (LARS), including 1 (0.7%) who suffered from complete incontinence, while 6 (4.2%) patients had minor LARS.ConclusionsTEM has satisfying long-term outcomes and relatively low anal function disturbance as for the treatment of small RNET. TEM also acts as a preferred salvage treatment for incomplete endoscopic excision.

Highlights

Rectal neuroendocrine tumor (RNET) has become the most common digestive neuroendocrine tumor (NET) recent years with the incidence of approximately 1/100,000 [1, 2]
We aim to summarize the long-term efficacy and safety of Transanal endoscopic microsurgery (TEM) in the treatment of rectal neuroendocrine tumors (RNET), as well as to evaluate patients’ anal function post-treatment
From December 2006 to June 2019, 144 consecutive RNET patients treated with TEM were included in this study

Summary

Introduction

Rectal neuroendocrine tumor (RNET) has become the most common digestive neuroendocrine tumor (NET) recent years with the incidence of approximately 1/100,000 [1, 2]. For local RNETs larger than 2 cm, several studies have shown that it is highly malignant and has a high incidence of local/distant metastasis [7, 8], so there is little debate about radical surgery as the preferred treatment [9]. TEM is a widely used transanal surgical technique, first introduced by Buess et al [10] in 1984, has the advantage of improved visualization and the ability to reach full-thickness resections. This technique is relatively safer with less morbidity than conventional transanal surgery and open surgery [11]. We aimed to assess the efficacy and safety of TEM in the treatment of rectal neuroendocrine tumors (RNET )

Objectives

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Results

Conclusion