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SHORT-TERM OUTCOMES OF ENDOSCOPIC RESECTION FOR COLORECTAL NEUROENDOCRINE TUMORS: A JAPANESE MULTICENTER PROSPECTIVE C-NET STUDY

Sayo Ito 1, Kinichi Hotta 1, Masau Sekiguchi 2, Yoji Takeuchi 3, Shiro Oka 4, Hironori Yamamoto 5, Kensuke Shinmura 6, Keita HARADA 7, Toshio Uraoka 8, Takashi Hisabe 9, Yasushi Sano 10, Hitoshi Kondo 11, Takahiro Horimatsu 12, Hidezumi Kikuchi 13, Takuji Kawamura 14, Shinji Nagata 15, Katsumi Yamamoto 16, Masahiro Tajika 17, Shigetsugu Tsuji 18, Toshihiro Kusaka 19, Yusuke Okuyama 20, Naohisa Yoshida 21, Tomohiko Moriyama 22, Aki Hasebe 23, Suketo So 24, Hideki Kobara 25, Hiroshi Kashida 26, Ryoichi Miyanaga 27, Sosuke Kato 28, Yoshito Hayashi 29, Kiyonori Kobayashi 30, Masakatsu Fukuzawa 31, Hiroyuki Kato 32, Tetsuji Takayama 33, Jun Konishi 34, Hiro-o Matsushita 35, Toshiaki Narasaka 36, Ken Ohata 37, Kazutomo Togashi 38, Hisashi Nakamura 39, Kentaro Moriichi 40, Yasushi Oda 41, Naoki Kanda 42, Toshio Kuwai 43, Shuji Terai 44, Makoto Sanomura 45, Shinji Kitamura 46, Hayato Miyamoto 47, Hideki Ishikawa 48, Takahisa Matsuda 49

Affiliations

1 Shizuoka Cancer Center, Shizuoka, Japan

2 National Cancer Center Hospital, Tokyo, Japan

3 Osaka International Cancer Institute, Osaka, Japan

4 Hiroshima University Hospital, Hiroshima, Japan

5 Jichi Medical University, Shimotsuke, Japan

6 National Cancer Center Hospital East, Kashiwa, Japan

7 Okayama University Hospital, Okayama, Japan

8 Gunma University Graduate School of Medicine, Maebashi, Japan

9 Fukuoka University Chikushi Hospital, Chikushino, Japan

10 Sano Hospital, Kobe, Japan

11 Tonan Hospital, Sapporo, Japan

12 Kyoto University Hospital, Kyoto, Japan

13 Hirosaki University Graduate School of Medicine, Hirosaki, Japan

14 Kyoto Second Red Cross Hospital, Kyoto, Japan

15 Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan

16 Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan

17 Aichi Cancer Center Hospital, Nagoya, Japan

18 Ishikawa Prefectural Central Hospital, Kanazawa, Japan

19 Kyoto Katsura Hospital, Kyoto, Japan

20 Kyoto First Red Cross Hospital, Kyoto, Japan

21 Kyoto Prefectural University of Medicine, Kyto, Japan

22 Kyushu University Hospital, Fukuoka, Japan

23 Shikoku Cancer Center, Matsuyama, Japan

24 Tobata Kyoritsu Hospital, Kitakyushu, Japan

25 Kagawa University, Kagawa, Japan

26 Kindai University Faculty of Medicine, Osaka-sayama, Japan

27 National Hospital Organization Tokyo Medical Center, Tokyo, Japan

28 NTT Medical Center Sapporo, Sapporo, Japan

29 Osaka University Graduate School of Medicine, Suita, Japan

30 Kitasato University Hospital, Sagamihara, Japan

31 Tokyo Medical University Hospital, Tokyo, Japan

32 Tokyo Women’s Medical University Adachi Medical Center, Tokyo, Japan

33 Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan

34 Tochigi Cancer Center, Utsunomiya, Japan

35 Akita Red Cross Hospital, Akita, Japan

36 University of Tsukuba Hospital, Tsukuba, Japan

37 NTT Medical Center Tokyo, Tokyo, Japan

38 Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan

39 Akasaka Endoscopic Clinic, Tokyo, Japan

40 Asahikawa Medical University, Asahikawa, Japan

41 Oda GI Endoscopy and Gastroenterology Clinic, Kumamoto, Japan

42 Takatsuki Red Cross Hospital, Takatsuki, Japan

43 National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan

44 Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

45 Hokusetsu General Hospital, Takatsuki, Japan

46 Sakai City Medical Center, Sakai, Japan

47 Hanwa Memorial Hospital, Osaka, Japan

48 Graduate School of Medicine Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

49 Toho University Omori Medical Center, Tokyo, Japan

Summary

AI Generated

A Japanese multicenter prospective cohort study found that three endoscopic resection techniques achieved similarly high complete resection rates and low complication rates for colorectal neuroendocrine tumors smaller than 10 mm.

Among 418 patients with 421 colorectal NETs treated endoscopically, en bloc resection was achieved in 100% and complete resection with tumor-free margins in 94.5% of lesions.
For lesions smaller than 10 mm, R0 resection rates were comparable across techniques: 95.5% for endoscopic mucosal resection with ligation device, 94.8% for endoscopic submucosal dissection, and 94.3% for endoscopic mucosal resection using a cap.
Treatment-related complications occurred in 3.8% of patients and all were managed conservatively without serious sequelae.
The lower rectum was the most common tumor location (88.6%), lesions smaller than 10 mm comprised 87% of cases, and median hospitalization was 3 days for the 63.4% of patients requiring admission.
No independent clinicopathological risk factors for incomplete resection were identified in this cohort.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

The incidence of colorectal neuroendocrine tumors (NETs) has increased over the past decades with early detection during screening colonoscopy.^1,2 The C-NET STUDY is a Japanese multicenter prospective cohort study, in which patients with colorectal NETs were consecutively enrolled.³

Aims & Methods

The study aimed to evaluate the short-term outcomes of various methods of endoscopic resection for colorectal NETs. Among the C-NET STUDY registrants, patients with colorectal NETs who underwent endoscopic treatment as the initial therapy were included. Patients who received treatment at a previous institution before participating in this study, biopsy diagnosed but the resected lesion was not pathologically diagnosed as NET, and who had defective data were excluded. The study protocol stated that endoscopic treatment should be performed if the tumor size is <10 mm in depth from the mucosa to the submucosa, with no ulceration or depression on the surface. For lesions with no treatment consensus in various guidelines, treatment selection was determined by each physician according to their policy in clinical practice. With respect to endoscopic resection procedures, several techniques were available in clinical practice, including endoscopic mucosal resection with a ligation device (ESMR-L), endoscopic mucosal resection using a cap (EMR-C), and endoscopic submucosal dissection (ESD). The major outcome measurements were short-term treatment outcomes, including en bloc resection rate, complete resection (defined as en bloc resection with tumor-free margin (R0)) rate, need for hospitalization, and treatment-related complications based on treatment modalities. Clinicopathological risk factors of incomplete resection (R1/RX) was also examined.

Results

A total of 472 patients with 477 colorectal NETs received endoscopic treatment. Of these, 418 patients with 421 lesions, who met the eligibility criteria, were included in the analysis. The median patient age was 55 years, and 56.9% of the patients were male. The lower rectum was the most common site (88.6%), and lesions <10 mm accounted for 87% of the cases. Among all cases, en bloc resection and R0 resection were achieved in 421 (100%) and 398 (94.5%) lesions. A total of 267 (63.4%) patients required hospitalization for treatment, with a median hospital stay of 3 days. Endoscopic mucosal resection with a ligation device (ESMR-L, 56.5%) was the most common method, followed by endoscopic submucosal dissection (ESD, 31.4%) and endoscopic mucosal resection using a cap (EMR-C, 8.5%). R0 resection rates <10 mm were 95.5%, 94.8 %, and 94.3% for ESMR-L, ESD, and EMR-C, respectively. All the treatment-related complications observed in 16 (3.8%) patients were treated conservatively. There were no independent clinicopathological risk factors for R1/X resection.

Conclusion

ESMR-L, ESD, and EMR-C were equally effective and safe techniques for colorectal NETs with diameter <10 mm (UMIN000025215).

References

Kooyker AI, Verbeek WH, van den Berg JG, et al. Change in incidence, characteristics and management of colorectal neuroendocrine tumours in the Netherlands in the last decade. United European Gastroenterol J 2020;8:59-67.
Ito T, Igarashi H, Nakamura K, et al. Epidemiological trends of pancreatic and gastrointestinal neuroendocrine tumors in Japan: a nationwide survey analysis. J Gastroenterol 2015;50:58-64.
Sekiguchi M, Hotta K, Takeuchi Y, et al. Characteristics of colorectal neuroendocrine tumors in patients prospectively enrolled in a Japanese multicenter study: a first report from the C-NET STUDY. J Gastroenterol 2022; 57: 547-558.

Conference

UEG Week Copenhagen 2023

Topics

Colorectal

Submission format

Abstract

Session

PP 06 Other lower GI disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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