A 55-year-old man with a 1.5 cm rectal neuroendocrine tumour (NET) at 6 cm from the anal verge, confined to the submucosa on endoscopic ultrasound, with no lymphadenopathy. Ki-67 index is 2%. What is the most appropriate management?
- A Endoscopic mucosal resection or transanal endoscopic microsurgery ✓
- B Low anterior resection with total mesorectal excision
- C Neoadjuvant chemotherapy followed by local excision
- D Abdominoperineal resection
Correct answer: A. Endoscopic mucosal resection or transanal endoscopic microsurgery
Explanation
Rectal NETs less than 2 cm, confined to the submucosa, with Ki-67 less than 3% and no lymphadenopathy are adequately treated by local excision (endoscopic or transanal). Radical surgery is reserved for tumours greater than 2 cm, muscularis invasion, or high-grade (Ki-67 greater than 3%). Neoadjuvant chemotherapy is not indicated for low-grade NETs.
Reference: NCCN Guidelines for Neuroendocrine Tumours, 2023 ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.