Fabozzi M, Zizzo M, Morini A, Dell'Atti L. Letter to the Editor: Management of incomplete resection of small rectal neuroendocrine tumours: An open question. World J Gastroenterol 2026; 32(34): 119968 [DOI: 10.3748/wjg.119968]
Corresponding Author of This Article
Lorenzo Dell'Atti, MD, Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola, 2, Reggio Emilia 42122, Emilia-Romagna, Italy. lorenzo.dellatti@ausl.re.it
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Surgery
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letter
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Fabozzi M, Zizzo M, Morini A, Dell'Atti L. Letter to the Editor: Management of incomplete resection of small rectal neuroendocrine tumours: An open question. World J Gastroenterol 2026; 32(34): 119968 [DOI: 10.3748/wjg.119968]
World J Gastroenterol. Sep 14, 2026; 32(34): 119968 Published online Sep 14, 2026. doi: 10.3748/wjg.119968
Letter to the Editor: Management of incomplete resection of small rectal neuroendocrine tumours: An open question
Massimiliano Fabozzi, Maurizio Zizzo, Andrea Morini, Lorenzo Dell'Atti
Massimiliano Fabozzi, Maurizio Zizzo, Andrea Morini, Lorenzo Dell'Atti, Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia 42122, Emilia-Romagna, Italy
Author contributions: Fabozzi M, Zizzo M, Morini A and Dell’Atti L contributed to the conception and design of the study, each author also contributed to manuscript drafting; Zizzo M, Morini A and Dell’Atti L contributed to collection, analysis and interpretation of available data; and all authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Lorenzo Dell'Atti, MD, Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola, 2, Reggio Emilia 42122, Emilia-Romagna, Italy. lorenzo.dellatti@ausl.re.it
Received: February 13, 2026 Revised: March 26, 2026 Accepted: May 7, 2026 Published online: September 14, 2026 Processing time: 189 Days and 9.9 Hours
Abstract
Management of incomplete resection of rectal neuroendocrine tumours remains an open clinical question. In the issue of the World Journal of Gastroenterology, Kim et al highlighted the heterogeneous incomplete resection rates across endoscopic techniques, while analysing impact of salvage treatment in this subset of patients. We further searched for evidence favouring a specific endoscopic technique for resection and the diagnostic and therapeutic role of salvage therapy in the long term. We performed a sensitivity meta-analysis restricted to studies with ≥ 36 months follow-up (5 studies; 413 patients) to compare recurrence rates between salvage therapy and observation. Our analysis showed no significant difference in recurrence (odds ratio = 0.89; 95% confidence interval: 0.37-2.18; P = 0.80), confirming the original findings even with extended follow-up. Subgroup analysis for local and distant recurrence did not show any significant difference.
Core Tip: This sensitivity meta-analysis of studies with ≥ 36 months follow-up confirms that salvage therapy does not significantly reduce recurrence rates compared with observation after incomplete resection of small rectal neuroendocrine tumours (odds ratio = 0.89, 95% confidence interval: 0.37-2.18). Despite a 25% residual tumour rate at salvage, long-term outcomes do not favour routine re-intervention. These findings challenge current clinical practice and support individualised management based on risk stratification rather than automatic salvage. However, given the low event rates and limited follow-up, current evidence supports shared decision-making with patients.
