Yes we need the surgeons but not for all NETs. Due to the implementation of the bowel cancer screening, we have ever been treating more and more small rectal neuroendocrine tumours (NETs). Our data suggested 42% of the NETs we treated was the ones incidentally found in the bowel cancer screening. Current ENET guideline suggested small rectal NETs are good candidates for endoscopic resection provided that complete pathological resection (R0) is obtained and their risk of metastatic progression is low. Optimal recognition and assessment of suspected NETs at an index procedure may be key to the effectiveness and completeness of subsequent endoscopic resection. This can be improved by the confirmation of round pit pattern (Kudo pit pattern type1) and firmness to palpation of the lesion. Amongst several endoscopic resection methods, advanced techniques such as ESD (endoscopic submucosal dissection), EMR-C (cap assisted EMR) or EMR-L (ligation assisted EMR) should be apply to NET to achieve local clearance at the higher rate. The basic technique was reported inferior for R0 resection (40% for mucosectomy and 17% for polypectomy)1. Endoscopic resection of NET is feasible and safe but it requires advanced techniques, therefore it should be restricted to experienced endoscopists. The long-term outcomes are excellent with R0 resection although distant metastasis may occur therefore appropriate surveillance should be considered.
02 Dec 2019
UK and Ireland Neuroendocrine Tumour Society