Application of endoscopic mucosal ligation resection in rectal neuroendocrine tumors
-
摘要:目的
比较套扎法内镜下黏膜切除术(EMR-b)和内镜下黏膜剥离术(ESD)对直肠神经内分泌肿瘤(NENs)的治疗效果。
方法回顾性分析56例接受ESD或EMR-b治疗的直肠NENs患者的资料,患者肿瘤直径均 < 10 mm且无淋巴系统转移。根据接受治疗的不同,将患者分为EMR-b组26例和ESD组30例。记录2组患者组织学完整切除率、并发症发生率和操作时间。
结果56例患者的平均年龄为(51.05±11.31)岁。EMR-b组肿瘤直径为(7.12±2.76) mm, ESD组为(7.47±2.32) mm, 2组肿瘤直径差异无统计学意义(P=0.599)。EMR-b组切除时间为(9.08±3.45) min, 短于ESD组的(18.50±3.25) min, 差异有统计学意义(P < 0.001)。EMR-b组完整切除率为92.31%(24/26), ESD组为93.33%(28/30), 2组完整切除率差异无统计学意义(P=1.000)。非完整切除患者随访期间无局部复发和远处转移。
结论与ESD相比, EMR-b有相似的组织学完整切除率,但切除时间更短,操作更简单, EMR-b对于直径 < 10 mm、不超过黏膜下层的直肠NENs是一种良好的内镜下治疗方法。
-
关键词:
- 套扎法内镜下黏膜切除术 /
- 内镜下黏膜剥离术 /
- 直肠 /
- 神经内分泌肿瘤
Abstract:ObjectiveTo compare the efficacy of endoscopic mucosal resection using band ligation(EMR-b) and endoscopic mucosal dissection(ESD) in the treatment of rectal neuroendocrine tumors(NENs).
MethodsThe data of 56 rectal NENs patients with rectal NENs < 10 mm in diameters, without lymphatic metastasis treated by ESD or EMR-b were retrospectively analyzed. According to different treatments, the patients were divided into EMR-B group (26 cases) and ESD group (30 cases). The complete resection rate, incidence of complications, and length of procedures were compared between the two groups.
ResultsThe mean age was (51.05±11.31) years old of 56 cases. The tumor size of EMR-B group was (7.12±2.76) mm, and was (7.47±2.32) mm in the ESD group, and the between-group difference in tumor size showed no significant difference (P=0.599). The resection time in EMR-B group was (9.08±3.45) min, which was shorter than (18.50±3.25) min in the ESD group, and the difference was statistically significant(P < 0.001). The complete resection rate of the EMR-B group was 92.31% (24/26), and was 93.33% (28/30) in the ESD group, and the difference was not statistically significant (P=1.000). In the cases of incomplete resection, there was neither local recurrence nor distant metastasis during the follow-up.
ConclusionCompared with ESD, EMR-b has similar histological complete resection rate, but has shorter resection time and simpler operation. EMR-b may be a better choice for rectal NENs with diameter < 10 mm and without invasion of submucosa.
-
-
表 1 2组患者基本情况及肿瘤基本特征(x±s)[n(%)]
指标 EMR-b组(n=26) ESD组(n=30) 全组(n=56) P 年龄/岁 49.04±11.71 52.80±10.85 51.05±11.31 0.210 男 12(46.15) 18(60.00) 30(53.57) 0.421 肿瘤直径/mm 7.12±2.76 7.47±2.32 7.30±2.52 0.599 距肛门距离/cm 5.81±1.92 6.73±2.78 6.30±2.44 0.153 住院时间/d 3.27±0.60 4.83±0.79 4.11±1.06 < 0.001 手术费用/元人民币 2 752.69±686.88 8 481.57±1 218.38 5 821.73±3 051.02 < 0.001 表 2 2组内镜治疗效果比较(x±s)[n(%)]
指标 EMR-b组(n=26) ESD组(n=30) 全组(n=56) P 完整切除 24(92.31) 28(93.33) 52(92.86) 1.000 水平切缘阳性 0 1(3.33) 1(1.80) 1.000 垂直切缘阳性 1(3.85) 1(3.33) 2(3.57) 1.000 切缘均阳性 1(3.85) 0 1(1.79) 0.464 切除时间/min 9.08±3.45 18.50±3.25 14.13±6.30 < 0.001 迟发出血 0 1(3.33) 1(1.79) 1.000 -
[1] WANG X Y, CHAI N L, LINGHU E Q, et al. Efficacy and safety of hybrid endoscopic submucosal dissection compared with endoscopic submucosal dissection for rectal neuroendocrine tumors and risk factors associated with incomplete endoscopic resection[J]. Ann Transl Med, 2020, 8(6): 368. doi: 10.21037/atm.2020.02.25
[2] OSAGIEDE O, HABERMANN E, DAY C, et al. Factors associated with worse outcomes for colorectal neuroendocrine tumors in radical versus local resections[J]. J Gastrointest Oncol, 2020, 11(5): 836-846. doi: 10.21037/jgo-20-193
[3] AVENEL P, MCKENDRICK A, SILAPASWAN S, et al. Gastrointestinal carcinoids: an increasing incidence of rectal distribution[J]. Am Surg, 2010, 76(7): 759-763. doi: 10.1177/000313481007600736
[4] SHIM K N, YANG S K, MYUNG S J, et al. Atypical endoscopic features of rectal carcinoids[J]. Endoscopy, 2004, 36(4): 313-316. doi: 10.1055/s-2004-814202
[5] CAPLIN M, SUNDIN A, NILLSON O, et al. ENETS Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms: colorectal neuroendocrine neoplasms[J]. Neuroendocrinology, 2012, 95(2): 88-97. doi: 10.1159/000335594
[6] BASUROY R, HAJI A, RAMAGE J K, et al. Review article: the investigation and management of rectal neuroendocrine tumours[J]. Aliment Pharmacol Ther, 2016, 44(4): 332-345. doi: 10.1111/apt.13697
[7] ONO A, FUJⅡ T, SAITO Y, et al. Endoscopic submucosal resection of rectal carcinoid tumors with a ligation device[J]. Gastrointestinal Endoscopy, 2003, 57(4): 583-587. doi: 10.1067/mge.2003.142
[8] NAGAI T, TORISHIMA R, NAKASHIMA H, et al. Saline-assisted endoscopic resection of rectal carcinoids: cap aspiration method versus simple snare resection[J]. Endoscopy, 2004, 36(3): 202-205. doi: 10.1055/s-2004-814248
[9] FUJISHIRO M, YAHAGI N, KAKUSHIMA N, et al. Outcomes of Endoscopic Submucosal Dissection for Colorectal Epithelial Neoplasms in 200 Consecutive Cases[J]. Clinical Gastroenterology and Hepatology, 2007, 5(6): 678-683. doi: 10.1016/j.cgh.2007.01.006
[10] TANAKA S, OKA S, KANEKO I, et al. Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization[J]. Gastrointestinal Endoscopy, 2007, 66(1): 100-107. doi: 10.1016/j.gie.2007.02.032
[11] CHOI C W, KANG D H, KIM H W, et al. Comparison of endoscopic resection therapies for rectal carcinoid tumor: endoscopic submucosal dissection versus endoscopic mucosal resection using band ligation[J]. J Clin Gastroenterol, 2013, 47(5): 432-436. doi: 10.1097/MCG.0b013e31826faf2b
[12] SOLCIA E, KLÖPPEL G, SOBIN L H. Histological Typing of Endocrine Tumours[M]. Heidelberg: Springer, 2000: 115-119.
[13] HE L, DENG T, LUO H. Efficacy and safety of endoscopic resection therapies for rectal carcinoid tumors: a meta-analysis[J]. Yonsei Med J, 2015, 56(1): 72-81. doi: 10.3349/ymj.2015.56.1.72
[14] SOGA J. Carcinoids of the rectum: an evaluation of 1271 reported cases[J]. Surg Today, 1997, 27(2): 112-119. doi: 10.1007/BF02385898
[15] KWAAN M R, GOLDBERG J E, BLEDAY R. Rectal carcinoid tumors: review of results after endoscopic and surgical therapy[J]. Arch Surg, 2008, 143(5): 471-475. doi: 10.1001/archsurg.143.5.471
[16] LEE J, PARK Y E, CHOI J H, et al. Comparison between cap-assisted and ligation-assisted endoscopic mucosal resection for rectal neuroendocrine tumors[J]. Ann Gastroenterol, 2020, 33(4): 385-390.
[17] MASHIMO Y, MATSUDA T, URAOKA T, et al. Endoscopic submucosal resection with a ligation device is an effective and safe treatment for carcinoid tumors in the lower rectum[J]. J Gastroenterol Hepatol, 2008, 23(2): 218-221. doi: 10.1111/j.1440-1746.2008.05313.x