Published online Aug 14, 2015. doi: 10.3748/wjg.v21.i30.9142
Peer-review started: February 26, 2015
First decision: March 26, 2015
Revised: April 9, 2015
Accepted: May 7, 2015
Article in press: May 7, 2015
Published online: August 14, 2015
Processing time: 172 Days and 12.1 Hours
AIM: To assess the efficacy of full-thickness excision using transanal endoscopic microsurgery (TEM) in the treatment of rectal neuroendocrine tumors.
METHODS: We analyzed the data of all rectal neuroendocrine tumor patients who underwent local full-thickness excision using TEM between December 2006 and December 2014 at our department. Data collected included patient demographics, tumor characteristics, operative details, postoperative outcomes, pathologic findings, and follow-ups.
RESULTS: Full-thickness excision using TEM was performed as a primary excision (n = 38) or as complete surgery after incomplete resection by endoscopic polypectomy (n = 21). The mean size of a primary tumor was 0.96 ± 0.21 cm, and the mean distance of the tumor from the anal verge was 8.4 ± 1.4 cm. The mean duration of the operation was 57.6 ± 13.7 min, and the mean blood loss was 13.5 ± 6.6 mL. No minor morbidities, transient fecal incontinence, or wound dehiscence was found. Histopathologically, all tumors showed typical histology without lymphatic or vessel infiltration, and both deep and lateral surgical margins were completely free of tumors. Among 21 cases of complete surgery after endoscopic polypectomy, 9 were histologically shown to have a residual tumor in the specimens obtained by TEM. No additional radical surgery was performed. No recurrence was noted during the median of 3 years’ follow-up.
CONCLUSION: Full-thickness excision using TEM could be a first surgical option for complete removal of upper small rectal neuroendocrine tumors.
Core tip: Rectal neuroendocrine tumors increase quickly and steadily. Although transanal endoscopic microsurgery (TEM) was widely used for rectal neoplasms, the application of TEM in the full-thickness excision of rectal neuroendocrine tumors has not been well investigated. We analyzed data of all rectal neuroendocrine tumor patients who underwent local full-thickness excision using TEM as a primary excision or as complete surgery after incomplete resection by endoscopic polypectomy. The results suggested that full-thickness excision using TEM is a safe, minimally invasive procedure which could achieve complete resection, and might be a first surgical option for complete removal of higher rectal neuroendocrine tumors of less than 2 cm.