PPS5. Endoscopic Resection Is Associated with Comparable Long-Term Outcomes to Surgical Resection for Small Colonic Neuroendocrine Tumors

Thursday, March 5, 2026

10:00 AM - 10:30 AM MST

Location: HUB Poster Park - West Hall 1-3

Poster Presenter(s)

Diamantis I. Tsilimigras, MD, PhD, MS

General Surgery Resident, PGY-3
Ohio State University
Columbus, Ohio, United States

Co-Author(s)

ES

Eric Swei, MD

Ohio State University
Columbus, Ohio, United States
BK

Bhavana Konda, MD

Medical Oncologist
Ohio State University
Columbus, Ohio, United States
Jordan M. Cloyd, MD

Associate Professor
The Ohio State University Wexner Medical Center, Division of Surgical Oncology
Columbus, Ohio, United States

Introduction: Although current guidelines recommend endoscopic resection (ER) for small rectal neuroendocrine tumors (NETs), colonic NETs have traditionally been considered more aggressive and the evidence to support ER for these neoplasms remains insufficient. We sought to compare long-term outcomes among patients who underwent ER versus surgical resection (SR) for colonic NETs using a nationwide cohort.

Methods: Data from the National Cancer Database (NCDB) were analyzed to identify patients who underwent ER or SR for colonic NET less than 2 cm between 2004-2019 and long-term overall survival (OS) was compared.

Results:

Among 5,529 patients who were treated for colonic NET, 308 (5.6%) underwent ER and 5,221 (94.4%) received SR. Patients who underwent ER were older (median age: 55 vs 50 years, p< 0.001), more likely to be African American (27.3% vs 9.6%, p< 0.001), and had similar Charlson-Deyo score compared to individuals who underwent SR (Charlson score> 2: 2.9% vs 3.7%, p=0.48). Median tumor size was slightly higher among patients who underwent SR versus ER (8 mm, IQR:4-12 vs 5 mm, IQR:3-7, p< 0.001), whereas incomplete resection was more common among individuals who underwent ER vs SR (11.4% vs 2.3%, p< 0.001). The 5- and 10-year OS among patients with colonic NET < 20mm was comparable following ER versus SR (5-year OS:90.9% vs 89.0%; 10-year OS:82.3% vs 77.3% , p=0.061, Figure), an association that remained consistent after adjusting for relevant clinicopathologic characteristics, including tumor size, lymph node status and surgical margins (aHR=0.90, 95%CI 0.89-1.25).

Conclusions: Among patients with colonic NETs < 2 cm, ER was associated with comparable long-term outcomes to SR. An endoscopic approach to small colonic NETs should be considered an acceptable approach, similar to current management of rectal NETs, when feasible.

Learning Objectives:

Recognize that long-term outcomes between ER and SR for small colonic NETs are comparable
Recognize that ER is associated with higher rates of incomplete resection, yet long-term outcomes remain comparable.