Is salvage surgery necessary for non-R0 endoscopic resection of small rectal neuroendocrine tumors?

doi:10.4251/wjgo.v18.i6.118531

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Oncol. Jun 15, 2026; 18(6): 118531
Published online Jun 15, 2026. doi: 10.4251/wjgo.v18.i6.118531

Is salvage surgery necessary for non-R0 endoscopic resection of small rectal neuroendocrine tumors?

Shi-Yong Lin, Ze-Hua Li, Guo-Liang Xu, Jun Weng, Kun-Hao Bai

Shi-Yong Lin, Ze-Hua Li, Guo-Liang Xu, Jun Weng, Kun-Hao Bai, Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China

Co-first authors: Shi-Yong Lin and Ze-Hua Li.

Co-corresponding authors: Jun Weng and Kun-Hao Bai.

Author contributions: Lin SY and Li ZH prepared the manuscript draft, they contributed equally to this article, they are the co-first authors of this manuscript; Lin SY, Li ZH, Weng J, and Bai KH collected and analyzed data; Xu GL, Weng J, and Bai KH provided research support and revised the manuscript; Weng J and Bai KH designed the research, they contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors read and approved the final manuscript.

Supported by the National Natural Science Foundation of China, No. 82403973 and No. 82373118; and the Guangdong Basic and Applied Basic Research Foundation, No. 2023A1515010828.

Institutional review board statement: This study was approved by the Medical Ethics Committee of Sun Yat-sen University Cancer Center, approval No. SL-B2023-722-01.

Informed consent statement: All participants were already asked to give signed informed consent before the operation. So, when this retrospective study was checked by the ethics committee, another informed consent was exempt.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: All data generated or analyzed during this study are included in this published article.

Corresponding author: Kun-Hao Bai, MD, PhD, Associate Chief Physician, Department of Endoscopy, Sun Yat-sen University Cancer Center, No. 651 Dongfengdong Street, Yuexiu District, Guangzhou 510060, Guangdong Province, China. baikh@sysucc.org.cn

Received: January 5, 2026
Revised: February 7, 2026
Accepted: March 19, 2026
Published online: June 15, 2026
Processing time: 155 Days and 17.3 Hours

Abstract

BACKGROUND

The rate of R0 endoscopic resection for small rectal neuroendocrine tumors (r-NETs) is nearly 90%. However, there is still controversy about subsequent treatment options for patients with non-R0 endoscopically resected r-NETs.

AIM

To investigate the necessity of salvage surgery for non-R0 endoscopic resection of small r-NETs.

METHODS

A single-center retrospective study. Thirty-eight patients with r-NETs who underwent non-R0 endoscopic resection at Sun Yat-sen University Cancer Centre between 2007 and 2023 were retrospectively analyzed.

RESULTS

Thirty patients underwent salvage surgery while 8 received follow-up only. Among those 30 patients with salvage surgery, 12 cases underwent salvage endoscopic submucosal dissection, while 16 underwent salvage transanal endoscopic microsurgery, 2 underwent salvage radical resection (low anterior resection). Postoperative pathology following salvage surgery indicated an absence of tumor cells in all 30 patients. Among the 8 patients who received follow-up only, 3 received endoscopic biopsy of the scar during follow-up. Pathological evaluation of the biopsy specimens also showed no residual tumor cells. All 38 patients underwent regular endoscopic and imaging follow-up with an average follow-up duration of 46.4 ± 14.8 months. No evidence of local tumor recurrence or distant metastasis was observed.

CONCLUSION

These findings suggest that salvage surgery may not be essential for patients with non-R0 endoscopically resected r-NETs, with regular follow-up being a safe alternative.

Keywords: Rectal neuroendocrine tumors; Endoscopic resection; Non-R0 resection; Salvage surgery; Follow-up

Core Tip: Rectal neuroendocrine tumors (r-NETs) are diminutive but potentially malignant neoplasms. The rate of R0 resection for endoscopic resection of small r-NETs is nearly 90%. However, there is still controversy about subsequent treatment options for patients with non-R0 endoscopically resected r-NETs. This retrospective study investigated 38 patients with non-R0 endoscopically resected r-NETs. Of these, 30 underwent salvage surgery while 8 received follow-up only. Postoperative pathology following salvage surgery indicated an absence of tumor cells in all 30 patients. No evidence of local tumor recurrence or distant metastasis was observed in all 38 patients during an average follow-up duration of 46.4 ± 14.8 months. These findings suggest that salvage surgery may not be essential for patients with non-R0 endoscopically resected r-NETs, with regular follow-up being a safe alternative.