Laparoscopic Versus Open Surgery for Rectal Neuroendocrine Tumors: A Multicenter Real-World Study

Abstract Background Due to the lack of large sample evidence-based medical studies, the surgical approach for radical resection of rectal neuroendocrine tumors is controversial. Methods We retrospectively collected the medical records of rectal neuroendocrine tumors patients who underwent radical resection at 17 large tertiary care hospitals in China, from January 1, 2010 to April 30, 2022. All patients were divided into laparoscopic surgery group and open surgery group. After propensity score matching was used to reduce confounders, postoperative and oncologic outcomes were compared between the groups. Results We enrolled 174 patients with rectal neuroendocrine tumors who underwent radical surgery. After random matching, 124 patients were included in the comparison (62 in the laparoscopic surgery group vs. 62 in the open surgery group). The laparoscopic surgery group had fewer complications(14.5% vs. 35.5%, P = 0.048) and superior relapse-free survival (P = 0.048). There was no significant difference in the R0 resection rate, operation time, and postoperative hospital stay. Subgroup analysis revealed that the laparoscopic surgery group had fewer complications (10.9% vs 34.7%, P = 0.004), shorter postoperative hospital stays (9.56 ± 5.21 days vs 12.31 ± 8.61 days, P = 0.049) and superior relapse-free survival (P = 0.025) in the rectal neuroendocrine tumors ≤ 4 cm subgroup. Conclusions Laparoscopic surgery is associated with improved postoperative outcomes and oncologic prognosis for patients with rectal neuroendocrine tumors ≤ 4 cm and can serve as a safe and feasible option of radical surgery of rectal neuroendocrine tumors.