Risk factors and clinical outcomes of incomplete endoscopic resection of small rectal neuroendocrine tumors in southern China: a 9-year data analysis

Xiaoduan Zhuang; Shaoheng Zhang; Guiquan Chen; Zongqi Luo; Huiqin Hu; Wenfeng Huang; Yu Guo; Yongwen Ouyang; Liang Peng; Qing Qing; Huiting Chen; Bingsheng Li; Jie Chen; Xinying Wang

doi:10.1093/gastro/goac084

Risk factors and clinical outcomes of incomplete endoscopic resection of small rectal neuroendocrine tumors in southern China: a 9-year data analysis

Gastroenterol Rep (Oxf). 2022 Dec 30:11:goac084. doi: 10.1093/gastro/goac084. eCollection 2023.

Authors

Xiaoduan Zhuang¹, Shaoheng Zhang¹, Guiquan Chen², Zongqi Luo², Huiqin Hu³, Wenfeng Huang³, Yu Guo⁴, Yongwen Ouyang⁵, Liang Peng⁶, Qing Qing⁷, Huiting Chen⁸, Bingsheng Li³, Jie Chen^{9

10}, Xinying Wang¹

Affiliations

¹ Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, P. R. China.
² Department of Gastroenterology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, P. R. China.
³ Department of Gastroenterology, Huizhou First Hospital, Huizhou, P. R. China.
⁴ Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China.
⁵ Department of Digestive Diseases, The First People's Hospital of Foshan, Foshan, P. R. China.
⁶ Department of Gastroenterology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, P. R. China.
⁷ Department of Gastroenterology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, P. R. China.
⁸ Department of Gastroenterology and Hepatology, Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, P. R. China.
⁹ Center for Neuroendocrine Tumors, Fudan University Shanghai Cancer Center, Shanghai, P. R. China.
¹⁰ Department of Head & Neck Tumors and Neuroendocrine Tumors, Fudan University Shanghai Cancer Center, Shanghai, P. R. China.

Abstract

Background: The histologically complete resection (CR) rate of small rectal neuroendocrine tumors (RNETs) is unsatisfactory at the first endoscopy. Risk factors and clinical outcomes associated with incomplete resection (IR) have not been explicitly elucidated. This study aims to explore the relevant factors of IR.

Methods: This retrospective study reviewed patients with small RNETs (≤10 mm) in eight centers from January 2013 to December 2021. Clinicopathological characteristics and clinical outcomes were compared between the CR and IR groups, and the polypectomy and advanced treatment groups.

Results: Of the 326 patients included, 83 (25.5%) were diagnosed with IR. Polypectomy (odds ratio [OR] = 16.86), a central depression (OR = 7.50), and treatment in the early period (OR = 2.60) were closely associated with IR. Further analysis revealed that an atypical hyperemic appearance (OR = 7.49) and treatment in the early period (OR = 2.54) were significantly associated with the inappropriate use of polypectomy (both P < 0.05). In addition, a total of 265 (81.3%) were followed up with a median follow-up period of 30.9 months. No death, metastasis, or recurrence was found during the follow-up period.

Conclusions: Polypectomy, a central depression, and treatment in the early period were risk factors for IR. Further, an atypical hyperemic appearance and treatment in the early period were significant predisposing factors for inappropriate choice of polypectomy. For histologically incompletely resected small RNETs, follow-up may be a safe and feasible alternative to rigorous salvage therapy.

Keywords: clinical outcomes; incomplete resection; rectal neuroendocrine tumors; risk factors.