Hu D, Yu J, Wang MX, Zhang HL. Redefining therapeutic thresholds and global guidelines: Toward precision management of intermediate-sized rectal neuroendocrine tumors. World J Gastroenterol 2025; 31(44): 114263 [DOI: 10.3748/wjg.v31.i44.114263]
Corresponding Author of This Article
Meng-Xue Wang, PhD, Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, No. 76 Linjiang Road, Yuzhong District, Chongqing 400010, China. 306419@hospital.cqmu.edu.cn
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Gastroenterology & Hepatology
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Editorial
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 28, 2025 (publication date) through Dec 1, 2025
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World Journal of Gastroenterology
ISSN
1007-9327
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Hu D, Yu J, Wang MX, Zhang HL. Redefining therapeutic thresholds and global guidelines: Toward precision management of intermediate-sized rectal neuroendocrine tumors. World J Gastroenterol 2025; 31(44): 114263 [DOI: 10.3748/wjg.v31.i44.114263]
World J Gastroenterol. Nov 28, 2025; 31(44): 114263 Published online Nov 28, 2025. doi: 10.3748/wjg.v31.i44.114263
Redefining therapeutic thresholds and global guidelines: Toward precision management of intermediate-sized rectal neuroendocrine tumors
Dan Hu, Jiang Yu, Meng-Xue Wang, Hao-Ling Zhang
Dan Hu, Department of Nursing, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
Jiang Yu, Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Meng-Xue Wang, Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
Hao-Ling Zhang, Department of Biomedical Science, Universiti Sains Malaysia, Pinang 13200, Malaysia
Co-first authors: Dan Hu and Jiang Yu.
Co-corresponding authors: Meng-Xue Wang and Hao-Ling Zhang.
Author contributions: Hu D and Yu J were responsible for study conception, literature review, and drafting of the manuscript as co-first authors; Wang MX and Zhang HL provided critical revisions and supervised the overall direction of the project as co-corresponding authors; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to this manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Meng-Xue Wang, PhD, Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, No. 76 Linjiang Road, Yuzhong District, Chongqing 400010, China. 306419@hospital.cqmu.edu.cn
Received: September 15, 2025 Revised: October 10, 2025 Accepted: October 22, 2025 Published online: November 28, 2025 Processing time: 74 Days and 11.9 Hours
Abstract
With the widespread adoption of colonoscopic screening, the detection rate of rectal neuroendocrine tumors (rNETs) has risen year by year. Treatment strategies for small (< 1 cm) and large (> 2 cm) lesions are relatively well established, but the optimal management pathway for intermediate-sized (1-2 cm) rNETs remains controversial. Inspired by the recent study by Kim et al, this editorial summarizes differences among international guidelines for managing intermediate-sized rNETs, the selection and latest advances in endoscopic techniques, and examines the feasibility and oncologic safety of endoscopic resection for intermediate-sized rNETs. We contend that future management should focus on the clinical application of molecular stratification, biomarkers, and dynamic risk modeling to enable individualized decision-making. Given global disparities in medical resources, a tiered care system based on risk stratification and resource availability should be established to ensure the safety, equity, and accessibility of rNETs treatment.
Core Tip: The management strategy for medium-sized rectal neuroendocrine tumors (rNETs) remains a subject of debate. Inspired by the latest research by Kim et al, this editorial summarizes the differences in international guidelines regarding management strategies, recent advances in endoscopic resection techniques, and their oncological safety. This editorial posits that, for medium-sized rNETs, endoscopic resection is emerging as a highly promising therapeutic option due to its minimally invasive nature, lower incidence of postoperative complications, and greater cost and time effectiveness.
