Sheng YH, Chen QY, Li XM, Zhou ZX, Xue TL. Defining endoscopic candidacy for intermediate size rectal neuroendocrine tumors. World J Gastroenterol 2026; 32(5): 114245 [DOI: 10.3748/wjg.v32.i5.114245]
Corresponding Author of This Article
Tian-Le Xue, PhD, School of Biomedical Science and Technology, Yaoda Education Technology Development (Nanjing) Co., Ltd, No. 180 Ruanzhu Avenue, Yuhuatai District, Nanjing 210012, Jiangsu Province, China. tianlexue114514@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
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/
Yu-Hang Sheng, Qi-Yang Chen, Xiao-Meng Li, Zhi-Xiang Zhou, Tian-Le Xue, School of Biomedical Science and Technology, Yaoda Education Technology Development (Nanjing) Co., Ltd, No. 180 Ruanzhu Avenue, Yuhuatai District, Nanjing 210012, Jiangsu Province, China
Co-first authors: Yu-Hang Sheng and Qi-Yang Chen.
Author contributions: Sheng YH and Chen QY conducted the literature review, assisted with manuscript writing and formatting, data interpretation and preparation as co-first authors; Li XM reviewed the clinical and endoscopic aspects and provided methodological suggestions; Zhou ZX provided critical revisions for intellectual content; Xue TL conceived the idea and drafted and critically revised the manuscript; all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Tian-Le Xue, PhD, School of Biomedical Science and Technology, Yaoda Education Technology Development (Nanjing) Co., Ltd, No. 180 Ruanzhu Avenue, Yuhuatai District, Nanjing 210012, Jiangsu Province, China. tianlexue114514@gmail.com
Received: September 15, 2025 Revised: October 31, 2025 Accepted: December 3, 2025 Published online: February 7, 2026 Processing time: 136 Days and 1.7 Hours
Abstract
Endoscopic resection is standard for small, well-differentiated rectal neuroendocrine tumors, but management of intermediate lesions remains unsettled. In a large single-center cohort with propensity score matching, endoscopic treatment of grade 1 tumors measuring 1.0-1.5 cm achieved high negative-margin rates and no observed recurrences over a median 54-month follow-up, mirroring outcomes for lesions < 1 cm. Lymphovascular invasion was absent in the intermediate group, and endoscopic submucosal dissection was used more often than mucosal resection. These data support endoscopic resection as a feasible organ preserving option in carefully staged, well differentiated intermediate size tumors. Priorities now include prospective, multicenter validation; standardized pre-resection staging with high-resolution endoscopy and endoscopic ultrasound; refined risk stratification incorporating depth and lymphovascular invasion; pragmatic surveillance schedules; and assessment of patient-reported outcomes, function, and costs. Developing decision tools and targeted training to optimize endoscopic technique may further expand safe, individualized care, and health economic analyses.
Core Tip: A matched analysis from a high-volume center suggests that well differentiated rectal neuroendocrine tumors measuring 1.0-1.5 cm can be managed safely with endoscopic resection when selection and technique are optimized. The absence of lymphovascular invasion and the lack of observed recurrences in the intermediate group argue for an organ preserving pathway with structured staging and follow up.
