直肠神经内分泌肿瘤非治愈性切除患者的临床转归

Clinical outcome of non-curative resection of rectal neuroendocrine tumours

目的评价经内镜切除的直肠神经内分泌肿瘤(RNETs)伴淋巴血管(LV)浸润或切缘阳性患者的临床转归。方法回顾性分析2011年1月至2018年12月44例于首都医科大学附属北京友谊医院治疗的存在LV浸润或切缘阳性的RNETs患者的临床资料。结果 385例RNETs患者中,44例病理确诊为RNETs伴LV浸润或切缘阳性,其中男性25例,女性19例,中位年龄57. 5岁(范围30~80岁)。病变完整切除率为87. 01%(335/385)。肿瘤直径为1~13mm,中位值为5. 5 mm;38个肿瘤直径<10 mm。36例采用内镜黏膜下剥离术(ESD),5例为内镜下黏膜切除术(EMR)和3例为经肛内镜显微手术(TEM)。病理表现为G1级40例,G2级4例。术后病理提示肿瘤垂直切缘阳性31例(26例为ESD,5例为EMR),水平及垂直切缘均阳性4例(均为ESD);LV浸润5例(均为ESD),垂直切缘阳性且LV浸润4例(均为ESD)。3例垂直切缘阳性或LV浸润的患者接受TEM作为补救治疗,术后病理未见肿瘤残留;其他41例患者接受内镜监测,无复发病例。随访7~74个月,中位值为24个月,所有患者均未出现淋巴结或远处转移。结论内镜切除术是RNET的有效治疗方式,术后伴切缘阳性或LV浸润患者可随访观察,但需严密监测。

Objective To evaluate the clinical outcomes of endoscopic resected rectal neuroendocrine tumors( rectal NETs) with positive margin or lymphovascular invasion( LVI) after initial resection. Methods The clinical data of 44 rectal NETs patients with LVI or positive margin treated in Beijing Friendship Hospital,Capital Medical University from January 2011 to December 2018 were retrospectively analyzed. Results Among 385 rectal NETs patients,44 were pathologically diagnosed with RNETs with LVI or positive margin,including 25 males and 19 females,with a median age of 57. 5 years( range 30-80 years). The histological complete resection rate was 87. 01%( 335/385). Tumor diameter was 1 to 13 mm,with a median of 5. 5 mm;38 tumors had a diameter of < 10 mm. Initial management involved endoscopic submucosal dissection( ESD) in 36 cases,endoscopic mucosal resection( EMR) in five and transanal endoscopic microsurgery( TEM) in three. The pathological manifestations were 40 cases of G1 grade and 4 cases of G2 grade. Postoperative pathology showed that 31 cases had positive vertical margin( 26 ESD and 5 EMR),4 had positive horizontal and vertical margins( ESD);5 had only LVI( ESD),4 had both positive vertical margin and LVI( ESD). 3 patients who had positive vertical margin or LVI received additional TEM treatment and there was no remnant tumour in final pathology.Other 41 patients were under endoscopic surveillance and there was no recurrence to be found. The follow-up period ranged from 7 to 74 months,with a median of 24 months. All patients had no lymph node or distant metastases. Conclusion Endoscopic Resection is an effective method to treat small rectal NETs,patients with positive margin or LVI can be followed up,but need close surveillance.