Efficacy and safety of modified endoscopic mucosal resection for rectal neuroendocrine tumors: a meta-analysis

Abstract

Purpose Rectal neuroendocrine tumors are rare with good prognosis. Several endoscopic methods such as endoscopic polypectomy, endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and modified endoscopic mucosal resection (m-EMR) are used in the treatment of rectal neuroendocrine tumors. Although m-EMR is derived from traditional EMR, it has not been widely used in clinical practice. In this study, we compared the efficacy and safety of EMR and m-EMR in the treatment of rectal neuroendocrine tumors by performing a meta-analysis.

Materials and Methods We searched PubMed, Web of Science, and EMBASE index up to the end of January 2017 for all published literature about EMR and m-EMR in the treatment of rectal neuroendocrine tumors.

Results A total of 11 studies involving 811 patients were included. The pooled data suggested that there was a significantly higher rate of histologic complete resection and endoscopic complete resection among patients treated with m-EMR than those treated with EMR (histologic complete resection: OR = 0.23, 95 % CI = 0.10–0.51, p < 0.01; endoscopic complete resection: OR = 0.13, 95 % CI = 0.02–0.74, p = 0.02). The procedure time of EMR was longer than m-EMR (MD = 2.40, 95 % CI = 0.33–4.46, p = 0.02). There was a significantly higher rate of vertical margin involvement among patients treated with EMR than those treated with m-EMR; whereas, there was no significant difference of lateral margin involvement between the m-EMR and EMR groups (vertical margin involvement: OR = 5.00, 95 % CI = 2.67–9.33, p < 0.01; lateral margin involvement: OR = 1.44, 95 % CI = 0.48–4.37, p = 0.52). There was no significant difference in mean tumor size among patients treated with m-EMR versus those treated with EMR (MD = −0.30, 95 % CI = −0.75–0.14, p = 0.18); further, there was no significant difference in endoscopic mean sizes of the tumor and pathological mean sizes of the tumor between the m-EMR and EMR groups (endoscopic mean sizes of the tumor: MD = 0.20, 95 % CI = −0.44–0.84, p = 0.43; pathological mean sizes of the tumor: MD = 0.62, 95 % CI = −0.68–1.92, p = 0.05). No significant differences were detected among the treatment groups with regard to complications (bleeding: OR = 0.87, 95 % CI = 0.39–1.95, p = 0.73; complications (bleeding and perforation): OR = 0.87, 95 % CI = 0.40–1.88, p = 0.73).

Conclusion The efficacy of m-EMR are better than EMR among patients undergoing endoscopic treatment of rectal neuroendocrine tumors, and the safety of m-EMR is equivalent to EMR treatment.

Zusammenfasung

Ziel Rektale neuroendokrine Tumore sind selten und haben eine gute Prognose. In der Therapie werden unterschiedliche endoskopische Verfahren wie endoskopische Polypektomie, endoskopische submuköse Dissektion (ESD), endoskopische Mukosaresektion (EMR) und modifizierte endoskopische Mukosaresektion (m-EMR) eingesetzt. Obwohl sich die modifizierte endoskopische Mukosaresektion von der traditionellen endoskopischen Mukosaresektion (EMR) ableitet, wurde diese Technik in der klinischen Praxis nicht häufig angewandt. In dieser Studie führen wir eine Meta-Analyse durch, um die Effizienz und Sicherheit von EMR und m-EMR bei der Behandlung von rektalen neuroendokrinen Tumoren zu vergleichen.

Material und Methoden Wir recherchierten die Verzeichnisse von PubMed, Web of Science und EMBASE bis Ende Januar 2017 nach allen veröffentlichten Artikeln über EMR und m-EMR bei der Behandlung von rektalen neuroendokrinen Tumoren.

Ergebnisse In die Meta-Analyse wurden 11 Studien mit insgesamt 811 Patienten eingeschlossen. Die erfassten Daten ließen darauf schließen, dass bei Patienten, die mit m-EMR behandelt wurden, eine signifikant höhere Rate von histologisch vollständiger Resektion und endoskopisch vollständiger Resektion vorlag als bei Patienten, die mit EMR behandelt worden waren (histologisch vollständige Resektion: OR = 0,23, 95 %CI = 0,10 bis 0,51, P < 0,01; endoskopisch vollständige Resektion: OR = 0,13, 95 % CI = 0,02 bis 0,74, P = 0,02). Die Eingriffsdauer war bei EMR länger als bei m-EMR (MD = 2,40, 95 % CI = 0,33 bis 4,46, P = 0,02). Es gab eine signifikant höhere Rate von vertikaler Randbeteiligung bei Patienten, die mit EMR behandelt worden waren als bei denen, die mit m-EMR behandelt worden waren; dagegen bestand kein signifikanter Unterschied zwischen der lateralen Randbeteiligung bei der m-EMR im Vergleich zur EMR Gruppe (vertikale Randbeteiligung: OR = 5,00, 95 % CI = 2,67 bis 9,33, P < 0,01; laterale Randbeteiligung: OR = 1,44, 95 % CI = 0,48 bis 4,37, P = 0,52). Es bestand kein signifikanter Unterschied zwischen der mittleren Tumorgröße bei Patienten der m-EMR Gruppe im Vergleich zur EMR Gruppe (MD = –0,30, 95 % CI = –0,75 bis 0,14, P = 0,18); des Weiteren gab es keinen signifikanten Unterschied zwischen der endoskopisch mittleren Größe des Tumors und der pathologisch mittleren Größe des Tumors zwischen der m-EMR und der EMR Gruppe (endoskopisch mittlere Tumorgröße: MD = 0,20, 95 % CI = –0,44 bis 0,84, P = 0,43; pathologisch mittlere Tumorgröße: MD = 0,62, 95 % CI = –0,68 bis 1,92, P = 0,05). Es konnten keine signifikanten Unterschiede zwischen den Behandlungsgruppen in Bezug auf Komplikationen festgestellt werden (Blutungen: OR = 0,87, 95 % CI = 0,39 bis 1,95, P = 0,73; Komplikationen (Blutung und Perforation): OR = 0,87, 95 % CI = 0,40 bis 1,88, P = 0,73).

Schlussfolgerung Bei Patienten mit rektalen neuroendokrinen Tumoren, bei denen eine Endoskopie durchgeführt wurde, zeigt m-EMR eine bessere Effizienz als EMR und die Sicherheit beider Behandlungsformen ist gleichwertig.

Key words

rectal neuroendocrine tumor - endoscopic mucosal resection - meta-analysis

Schlüsselwörter

rektale neuroendokrine Tumore - endoskopische Mukosaresektion - Meta-Analyse

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