ABSTRACT

Introduction

Well-differentiated gastric, duodenal, and rectal neuroendocrine neoplasms (NETs) are rare diseases usually managed by endoscopic treatment. Although several endoscopic techniques are available, the number of patients with incomplete (R1) resection is significant.

Areas covered

This review focuses on the meaning of incomplete R1 findings after endoscopic resection in type I gastric NETs; nonfunctioning, non-ampullary duodenal NETs; and small rectal NETs. Data were identified by MEDLINE database search without publication date limitation.

Expert opinion

An incomplete R1 finding may have no significant impact on a patient’s clinical outcome, particularly in small G1 type I gastric NETs, which have an indolent course. A ‘stepwise approach,’ which uses more advanced endoscopic techniques, or minimally invasive surgery may be justified to achieve complete margin-free resection. This approach must balance the tumor features and the procedure-related risk of complications, particularly in the duodenum, where the role of deep endoscopic resections is limited due to the thin duodenal wall. Gastric and rectal NETs that are incompletely removed after initial resection are more easily amenable to deep endoscopic techniques. However, this might not be necessary for patients with comorbidities, elderly, or both due to the uncertainty of how R1 finding impacts a patient’s clinical outcome.

中文翻译：

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内镜下切除胃、十二指肠、直肠神经内分泌肿瘤后R1切除的意义

摘要

介绍

高分化胃、十二指肠和直肠神经内分泌肿瘤（NET）是罕见疾病，通常通过内镜治疗进行治疗。尽管有多种内窥镜技术可用，但不完全（R1）切除的患者数量仍然很大。

覆盖领域

本综述重点关注 I 型胃 NET 内镜切除术后不完整 R1 结果的意义；无功能、非壶腹的十二指肠 NET；和小直肠网。数据通过 MEDLINE 数据库检索确定，无发表日期限制。

专家意见

不完整的 R1 结果可能对患者的临床结果没有显着影响，特别是对于具有惰性病程的小型 G1 I 型胃 NET。使用更先进的内窥镜技术或微创手术的“逐步方法”可能可以实现完全无切缘切除。这种方法必须平衡肿瘤特征和手术相关的并发症风险，特别是在十二指肠，由于十二指肠壁薄，深部内窥镜切除术的作用受到限制。初次切除后未完全切除的胃和直肠 NET 更容易采用深部内窥镜技术。然而，由于 R1 的发现如何影响患者的临床结果的不确定性，这对于患有合并症的患者、老年人或两者兼有的患者来说可能没有必要。