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Original Article
Colorectal cancer
Stratification of rate of lymph node metastasis according to risk factors and oncologic outcomes in patients who underwent radical resection for rectal neuroendocrine tumors
Myung Jae Jin, Sung Sil Park, Dong-Eun Lee, Sung Chan Park, Dong Woon Lee, Kiho You, Hee Jin Chang, Chang Won Hong, Dae Kyung Sohn, Kyung Su Han, Bun Kim, Byung Chang Kim, Jae Hwan Oh
Ann Coloproctol. 2023;39(6):467-473.   Published online April 28, 2023
DOI: https://doi.org/10.3393/ac.2022.00913.0130
  • 3,192 View
  • 131 Download
  • 1 Web of Science
  • 1 Citations
AbstractAbstract PDFSupplementary Material
Purpose
Most predictive factors for lymph node metastasis in rectal neuroendocrine tumors (NETs) have been based on local and endoscopic resection. We aimed to evaluate the risk factors for lymph node metastasis in patients who underwent radical resection for rectal NETs and stratify the risk of lymph node metastasis.
Methods
Sixty-four patients who underwent radical resection for rectal NETs between January 2001 and January 2018 were included. We investigated the risk factors of lymph node metastasis using clinicopathologic data. We also performed a risk stratification for lymph node metastases using the number of previously known risk factors. For oncologic outcomes, the 5-year overall survival and recurrence-free survival were evaluated in both groups.
Results
Among the patients who underwent radical surgery, 32 (50.0%) had lymph node metastasis and 32 (50.0%) had non–lymph node metastasis. In the multivariable analysis, only the male sex was identified as a risk factor for lymph node metastasis (odds ratio, 3.695; 95% confidence interval, 1.128–12.105; P=0.031). When there were 2 or more known risk factors, the lymph node metastasis rate was significantly higher than when there were one or no risk factors (odds ratio, 3.667; 95% confidence interval, 1.023–13.143; P=0.046). There was also no statistical difference between the 2 groups in 5-year overall survival (P=0.431) and 5-year recurrence-free survival (P=0.144).
Conclusion
We found that the rate of lymph node metastasis increased significantly when the number of known risk factors is 2 or more.

Citations

Citations to this article as recorded by  
  • Lateral pelvic lymph nodes dissection of rectal neuroendocrine neoplasms: A prospective case-series and literature review
    Yueyang Zhang, Yi Yang, Changyuan Gao, Hong Zhao, Haitao Zhou
    Surgery.2024; 176(5): 1360.     CrossRef
Case Report
Rare disease & stoma
A small, low-grade rectal neuroendocrine tumor with lateral pelvic lymph node metastasis: a case report
Seonhui Shin, Young-In Maeng, Seyun Jung, Chun-Seok Yang
Ann Coloproctol. 2022;38(4):327-331.   Published online March 7, 2022
DOI: https://doi.org/10.3393/ac.2021.00899.0128
  • 3,619 View
  • 172 Download
  • 4 Web of Science
  • 7 Citations
AbstractAbstract PDF
Rectal neuroendocrine tumors (NETs) are typically small lesions that are confined to the submucosa and have favorable behavior at the time of diagnosis. Local endoscopic or surgical resection is recommended because lymph node metastasis is very rare. In this report, we present the case of a 36-year-old male presenting with an incidentally found rectal mass during screening colonoscopy. Pathologic examination of the primary tumor revealed a 9-mm grade 1 NET with submucosal invasion and no significant aggressive factors except for central ulceration. However, radiologic studies revealed a suspected 2.6-cm mesorectal lymph node metastasis and multiple left internal iliac lymph node metastases. We performed laparoscopic intersphincteric resection with left lateral pelvic lymph node dissection. The final pathologic report revealed a metastatic lymph node with low grade, low mitotic count, and low Ki-67 index. We describe an overview of lymph node metastasis of rectal NETs focusing on lateral pelvic lymph node metastasis.

Citations

Citations to this article as recorded by  
  • Risk factors for and prognostic impact of lateral pelvic lymph node metastasis in patients with rectal neuroendocrine tumors: a single-center retrospective analysis of 214 cases with radical resection
    Tsubasa Sakurai, Y. Hiyoshi, N. Daitoku, S. Matsui, T. Mukai, T. Nagasaki, T. Yamaguchi, T. Akiyoshi, H. Kawachi, Y. Fukunaga
    Surgery Today.2025; 55(2): 144.     CrossRef
  • Construction and evaluation of the prediction model for advanced disease in well-differentiated colorectal neuroendocrine neoplasms less than 2 cm in diameter
    Hongda Yin, Yanan Chen, Wei Zhao, Fuqiang Zhao, Zhijun Huang, Aimin Yue, Zhijie Wang
    Heliyon.2025; 11(1): e41197.     CrossRef
  • Primary small rectal neuroendocrine tumor with pelvic lateral lymph nodes metastasis: A case report and review of literature
    Lihong Li, Ziyue Chen, Dajian Zhu, Qianbao Lv, Tianpeng Zhang, Jinsong Lai
    International Journal of Surgery Case Reports.2025; 127: 110963.     CrossRef
  • Risk factors for lateral pelvic lymph node metastasis in patients with rectal neuroendocrine tumors: a systematic review and meta-analysis
    Ziyue Chen, Dajian Zhu
    Frontiers in Oncology.2025;[Epub]     CrossRef
  • Successfully Resected Isolated Lateral Lymph Node Recurrence in a Patient with T1 Lower Rectal Cancer: Case Report and Literature Review
    Kazuma Rifu, Koji Koinuma, Hisanaga Horie, Katsusuke Mori, Daishi Naoi, Mineyuki Tojo, Yuko Homma, Satoshi Murahashi, Atsushi Kihara, Toshiki Mimura, Joji Kitayama, Naohiro Sata
    Journal of the Anus, Rectum and Colon.2024; 8(3): 259.     CrossRef
  • Clinical application of endoscopic ultrasonography in the management of rectal neuroendocrine tumors
    Soo-Young Na, Seong Jung Kim, Hyoun Woo Kang
    International Journal of Gastrointestinal Intervention.2023; 12(3): 105.     CrossRef
  • Multiple rectal neuroendocrine tumors: An analysis of 15 cases and literature review
    Shu Pang, Ye Zong, Kun Zhang, Haiying Zhao, Yongjun Wang, Junxiong Wang, Chuntao Liu, Yongdong Wu, Peng Li
    Frontiers in Oncology.2022;[Epub]     CrossRef
Original Articles
Malignant disease,Prognosis
Recurrence after endoscopic resection of small rectal neuroendocrine tumors: a retrospective cohort study
Sukit Pattarajierapan, Supakij Khomvilai
Ann Coloproctol. 2022;38(3):216-222.   Published online July 20, 2021
DOI: https://doi.org/10.3393/ac.2021.00017.0002
  • 6,065 View
  • 183 Download
  • 2 Web of Science
  • 2 Citations
AbstractAbstract PDF
Purpose
According to the European Neuroendocrine Tumor Society consensus guidelines, rectal neuroendocrine tumors (NETs) up to 10 mm in size and without poor prognostic factors could be safely removed with endoscopic resection, suggesting omitting surveillance colonoscopy after complete resection. However, the benefit of surveillance colonoscopy is still unknown. In this study, we aimed to report the outcomes after endoscopic resection of small rectal NETs using our surveillance protocol.
Methods
This retrospective cohort study included patients who underwent endoscopic resection for rectal NETs sized up to 10 mm from January 2013 to December 2019 at our center. We excluded patients without surveillance colonoscopy and those lost to follow-up. We strictly performed surveillance colonoscopy 1 year after endoscopic resection, and every 2 to 3 years thereafter. The primary outcomes were tumor recurrence and occurrence of metachronous tumors during followup.
Results
Of the 54 patients who underwent endoscopic resection for rectal NETs during the study period, 46 were enrolled in this study. The complete resection rates by endoscopic mucosal resection, precutting endoscopic mucosal resection, and endoscopic submucosal dissection were 92.3% (12 of 13), 100% (21 of 21), and 100% (12 of 12), respectively. There was no local or distant recurrence during the median follow-up of 39 months. However, we found that 8.7% (4 of 46) of patients developed metachronous NETs. All metachronous lesions were treated with precutting endoscopic mucosal resection.
Conclusion
Surveillance colonoscopy is reasonable after endoscopic resection of small rectal NETs for timely detection and treatment of metachronous lesions. However, larger collaborative studies are needed to influence the guidelines.

Citations

Citations to this article as recorded by  
  • Comparison of the efficacy of endoscopic submucosal dissection and transanal endoscopic microsurgery in the treatment of rectal neuroendocrine tumors ≤ 2 cm
    Rui Jin, Xiaoyin Bai, Tianming Xu, Xi Wu, Qipu Wang, Jingnan Li
    Frontiers in Endocrinology.2023;[Epub]     CrossRef
  • Current status of the role of endoscopy in evaluation and management of gastrointestinal and pancreatic neuroendocrine tumors
    Zaheer Nabi, Sundeep Lakhtakia, D. Nageshwar Reddy
    Indian Journal of Gastroenterology.2023; 42(2): 158.     CrossRef
Malignant disease,Prognosis and adjuvant therapy
Analysis of the Incidence and Clinical Features of Colorectal Nonadenocarcinoma in Korea: A National Cancer Registry-Based Study
Soomin Nam, Dongwook Kim, Kyuwon Jung, Yoon Jung Choi, Jung Gu Kang
Ann Coloproctol. 2020;36(6):390-397.   Published online May 15, 2020
DOI: https://doi.org/10.3393/ac.2020.05.03.2
  • 3,578 View
  • 111 Download
  • 10 Web of Science
  • 10 Citations
AbstractAbstract PDF
Purpose
Although most colorectal malignancies are adenocarcinomas from mucosa, various types of malignant and benign tumors can develop. Due to extremely low incidence, little research has been conducted. The purpose was to assess incidence and compare it according to demographic factors.
Methods
Data from the Korea National Cancer Registry from 2007 to 2016 were used. The crude incidence, age-standard incidence rate (ASR) of colorectal nonadenocarcinomas were calculated.
Results
Over 11 years, there were 267,142 patients with colorectal malignancies. The patients of 14,495 (5.43%) were diagnosed with nonadenocarcinoma. The ASR was 2.52 per 100,000 in men and 1.56 in women. Lesions were classified according to histologic categories; neuroendocrine tumor (NET) was the most common malignancy (10,919 [75.33%]). Nonadenocarcinoma was the most common in 40s and 50s (40 to 49 years, 3,530 [24.35%]; 50 to 59 years, 3,991 [27.53%]). Lymphoma was high (54.46%) in patients in teenagers. Proportion of NET decreased with age and that of carcinoma increased with age. Carcinoma, sarcoma, and lymphoma were more common among men and melanoma was more common among women. The most common site was the rectum (11,066 [76.34%]). Lymphoma occurred more frequently in proximal colon. Melanoma, gastrointestinal stromal tumor, and NET occurred mostly in rectum. A total of 10,155 patients (70.06%) were classified as having localized disease.
Conclusion
This study is meaningful as it is the first study to examine incidence of colorectal nonadenocarcinoma. Differences in incidence of different lesions based on demographic factors were identified. This study will play a role in cancer prevention and diagnosis projects.

Citations

Citations to this article as recorded by  
  • Risk Factor Analysis of Lymph Node Metastasis for Rectal Neuroendocrine Tumors: Who Needs a Radical Resection in Rectal Neuroendocrine Tumors Sized 1–2 cm?
    Jin Sun Choi, Min Jung Kim, Rumi Shin, Ji Won Park, Seung Chul Heo, Seung-Yong Jeong, Kyu Joo Park, Seung-Bum Ryoo
    Annals of Surgical Oncology.2024; 31(4): 2414.     CrossRef
  • Assessing risk stratification in long-term outcomes of rectal neuroendocrine tumors following endoscopic resection: a multicenter retrospective study
    Hyun Jin Lee, Yun Seo, Chang Kyo Oh, Ji Min Lee, Hyun Ho Choi, Tae-Geun Gweon, Sung-Hak Lee, Dae Young Cheung, Jin Il Kim, Soo-Heon Park, Han Hee Lee
    Scandinavian Journal of Gastroenterology.2024; 59(7): 868.     CrossRef
  • Oncological outcomes according to the treatment modality based on the size of rectal neuroendocrine tumors: a single-center retrospective study
    Jimin Son, In Ja Park, Dong-Hoon Yang, Jisup Kim, Kyoung-Jo Kim, Jeong-Sik Byeon, Seung Mo Hong, Young Il Kim, Jong Beom Kim, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
    Surgical Endoscopy.2022; 36(4): 2445.     CrossRef
  • Epidemiology, risk factors, and prevention of colorectal cancer
    Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim
    Journal of the Korean Medical Association.2022; 65(9): 549.     CrossRef
  • Direction of diagnosis and treatment improvement in colorectal cancer
    In Ja Park
    Journal of the Korean Medical Association.2022; 65(9): 540.     CrossRef
  • Epidemiology, Risk Factors, and Prevention of Colorectal Cancer-An English Version
    Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim
    Journal of the Anus, Rectum and Colon.2022; 6(4): 231.     CrossRef
  • Update on Diagnosis and Treatment of Colorectal Cancer
    Chan Wook Kim
    The Ewha Medical Journal.2022;[Epub]     CrossRef
  • Trends in the Incidence and Survival Rates of Colorectal Signet-Ring Cell Carcinoma in the South Korean Population: Analysis of the Korea Central Cancer Registry Database
    Ji-Hoon Kim, Hyunil Kim, Jin Woo Kim, Hee Man Kim
    Journal of Clinical Medicine.2021; 10(18): 4258.     CrossRef
  • Primary tumor location (right versus left side of the colon) and resection affect the survival of patients with liver metastases from colonic neuroendocrine carcinoma: a population-based study
    Wen Cai, Weiting Ge, Jiawei Zhang, Siyuan Xie, Dehao Wu, Hanguang Hu, Jianshan Mao
    Therapeutic Advances in Gastroenterology.2021;[Epub]     CrossRef
  • Colorectal Nonadenocarcinoma in South Korea
    Jung Wook Huh
    Annals of Coloproctology.2020; 36(6): 359.     CrossRef
Transanal Endoscopic Microsurgery for the Treatment of Well-Differentiated Rectal Neuroendocrine Tumors
Hyoung Ran Kim, Woo Yong Lee, Kyung Uk Jung, Hyuk Jun Chung, Chul Joong Kim, Hae-Ran Yun, Yong Beom Cho, Seong Hyeon Yun, Hee Cheol Kim, Ho-Kyung Chun
J Korean Soc Coloproctol. 2012;28(4):201-204.   Published online August 31, 2012
DOI: https://doi.org/10.3393/jksc.2012.28.4.201
  • 4,376 View
  • 31 Download
  • 8 Citations
AbstractAbstract PDF
Purpose

Recently, an increase in well-differentiated rectal neuroendocrine tumors (WRNETs) has been noted. We aimed to evaluate transanal endoscopic microsurgery (TEM) for the treatment of WRNETs.

Methods

Between December 1995 and August 2009, 109 patients with WRNETs underwent TEM. TEM was performed for patients with tumors sizes of up to 20 mm and without a lymphadenopathy. These patients had been referred from other clinics after having been diagnosed with WRNETs by using a colonoscopic biopsy; they had undergone a failed endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) and exhibited an involved resection margin and remaining tumor after ESD or EMR, regardless of the distance from the anal verge. This study included 38 patients that had more than three years of follow-up.

Results

The mean age of the patients was 51.3 ± 11.9 years, the mean tumor size was 8.0 ± 3.9 mm, and no morbidity occurred. Thirty-five patients were asymptomatic. TEM was performed after a colonoscopic resection in 13 cases because of a positive resection margin, a residual tumor or a non-lifting lesion. Complete resections were performed in 37 patients; one patient with a positive margin was considered surgically complete. In one patient, liver metastasis and a recurrent mesorectal node occurred after five and 10 years, respectively.

Conclusion

TEM might provide an accessible and effective treatment either as an initial or as an adjunct after a colonoscopic resection for a WRNET.

Citations

Citations to this article as recorded by  
  • Oncological outcomes according to the treatment modality based on the size of rectal neuroendocrine tumors: a single-center retrospective study
    Jimin Son, In Ja Park, Dong-Hoon Yang, Jisup Kim, Kyoung-Jo Kim, Jeong-Sik Byeon, Seung Mo Hong, Young Il Kim, Jong Beom Kim, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
    Surgical Endoscopy.2022; 36(4): 2445.     CrossRef
  • Long-term outcomes of transanal endoscopic microsurgery for the treatment of rectal neuroendocrine tumors
    Wei-Kun Shi, Rui Hou, Yun-Hao Li, Xiao-Yuan Qiu, Yu-Xin Liu, Bin Wu, Yi Xiao, Jiao-Lin Zhou, Guo-Le Lin
    BMC Surgery.2022;[Epub]     CrossRef
  • Non-conventional applications for transanal endoscopic microsurgery. A single center experience and a systematic review of literature
    Rosita DE VINCENTI, Fabio CIANCHI, Francesco CORATTI
    Minerva Surgery.2022;[Epub]     CrossRef
  • Transanalis műtéti útmutató – második kiadás
    Kálmán Almási, Szabolcs Ábrahám, József Baracs, Attila Bursics, Zoltán Jánó, Tamás Sztipits, Áron Szűts, Dezső Tóth, Attila Zaránd, Balázs Bánky
    Orvosi Hetilap.2022; 163(Supplement): 3.     CrossRef
  • Endoscopic submucosal dissection versus transanal local excision for rectal carcinoid: a comparative study
    Fei-hu Yan, Zheng Lou, Shi-jie Hu, Xiao-dong Xu, Hao Wang, Han-tao Wang, Rong-gui Meng, Chuan-gang Fu, Wei Zhang, Jian He, En-da Yu
    World Journal of Surgical Oncology.2016;[Epub]     CrossRef
  • Efficacy and Safety of Endoscopic Resection Therapies for Rectal Carcinoid Tumors: A Meta-Analysis
    Lei He, Tao Deng, Hesheng Luo
    Yonsei Medical Journal.2015; 56(1): 72.     CrossRef
  • Full-thickness excision using transanal endoscopic microsurgery for treatment of rectal neuroendocrine tumors
    Wei-Jie Chen
    World Journal of Gastroenterology.2015; 21(30): 9142.     CrossRef
  • Current Issues Involving the Treatment of Small Rectal Carcinoid Tumors
    Dae Kyung Sohn
    Journal of the Korean Society of Coloproctology.2012; 28(4): 176.     CrossRef
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