Redefining therapeutic thresholds and global guidelines: Toward precision management of intermediate-sized rectal neuroendocrine tumors

Table 1 Comparison of international guideline strategies for the management of 1-2 cm rectal neuroendocrine tumors

Guideline	Primary recommendation for 1-2 cm rectal neuroendocrine tumors	Key considerations
Japan (JNETS)	Radical surgical resection + lymph node dissection	The most aggressive strategy. Considers the risk of metastasis in this size range to be sufficiently high to warrant a radical approach
Europe (ENETS)	Individualized decision-making (endoscopy or surgery) after multidisciplinary team discussion	Offers the highest degree of flexibility; decisions are heavily dependent on risk factors (lymphovascular invasion, muscularis invasion, grade)
Canada (Canadian Neuroendocrine Tumor Society)	Individualized assessment; local excision considered if no risk factors, radical surgery if risk factors are present	Employs a risk-stratified approach positioned between ENETS and JNETS, emphasizing shared decision-making with the patient
North America (National Comprehensive Cancer Network)	Local excision followed by 1 year of close surveillance	Accepts local excision as the initial treatment but mandates subsequent imaging and endoscopic follow-up
China (Chinese Society of Clinical Oncology)	Local excision (transanal)	Favors a more thorough local excision than endoscopic methods; recommends radical surgery directly for higher stages

ENETS: European Neuroendocrine Tumor Society; JNETS: Japanese Neuroendocrine Tumor Society.