直肠神经内分泌肿瘤相对罕见。接受根治性手术的直肠神经内分泌肿瘤患者淋巴结转移率较高。关于侧盆腔淋巴结转移的状况以及侧盆腔淋巴结清扫术在这些患者中的作用尚缺乏有力的证据。本病例系列研究旨在探讨和解决这些问题。这个单中心、前瞻性病例系列连续入组2022年6月至2024年1月期间在三级转诊医院活检证实的直肠神经内分泌肿瘤患者。所有符合条件的患者均接受腹腔镜全直肠系膜切除术。全身麻醉下进行切除手术和双侧盆腔外侧淋巴结清扫术。介绍了临床病理特征、手术结果和术后并发症。最后一次随访于 2024 年 3 月进行。共有 11 名直肠神经内分泌肿瘤患者入组，其中 3 名女性和 8 名男性。平均年龄为 60.0 岁（范围为 53.5-65.5 岁），中位肿瘤大小为 2.0 厘米（范围为 1.6-2.5 厘米）。 7例患者肿瘤侵犯固有肌层。神经内分泌瘤G1 3例，神经内分泌瘤G2 6例，神经内分泌癌2例。其中，11例（100.0%）有淋巴结转移，6例（54.5%）有盆腔外侧淋巴结转移。此外，2例患者仅观察到盆腔外侧淋巴结转移，未累及肠系膜淋巴结。 5例患者肿瘤位于直肠左壁，仅观察到左侧盆腔外侧淋巴结转移。另一名患者因肿瘤围绕直肠环向生长，出现两侧盆腔外侧淋巴结转移。所有患者均实现了肛门保留。中位手术时间为 235.0 分钟（范围：210.5-335.5 分钟），中位估计失血量为 50.0 mL（范围：45.0-75.0 mL）。两名患者出现术后排尿困难，并在术后 2-4 个月内自然恢复。在前瞻性病例系列的基础上，我们首次证明了需要根治性全直肠系膜切除术的直肠神经内分泌肿瘤患者的侧盆腔淋巴结转移状况切除手术。由于缺乏明确的新辅助或辅助治疗选择，同时进行双侧侧盆腔淋巴结清扫可能是预防这些患者局部复发的可行且有益的手术。版权所有 © 2024 作者。由爱思唯尔公司出版。保留所有权利。

Rectal neuroendocrine neoplasms are relatively rare. Patients with rectal neuroendocrine neoplasms undergoing radical surgery have a higher rate of lymph node metastases. Robust evidence on the status of lateral pelvic lymph node metastases and the role of lateral pelvic lymph node dissection in those patients is lacking. This case-series study aimed to explore and address these issues.This single-center, prospective case series consecutively enrolled patients with biopsy-proven rectal neuroendocrine neoplasms in a tertiary referral hospital between June 2022 and January 2024. All eligible patients underwent laparoscopic total mesorectal excision surgery and bilateral lateral pelvic lymph node dissection under general anesthesia. The clinicopathologic features, surgical outcomes, and postoperative complications were presented. The last follow-up was conducted in March 2024.A total of 11 patients with rectal neuroendocrine neoplasms-3 female and 8 male-were enrolled. The average age was 60.0 years (range, 53.5-65.5 years), and the median tumor size was 2.0 cm (range, 1.6-2.5 cm). Tumors invaded the muscularis propria in 7 patients. There were 3 cases of neuroendocrine tumor G1, 6 cases of neuroendocrine tumor G2, and 2 cases of neuroendocrine carcinoma. Among these patients, 11 (100.0%) had lymph node metastases, and 6 (54.5%) had lateral pelvic lymph node metastases. In addition, in 2 patients, only lateral pelvic lymph node metastases were observed, without involvement of the mesenteric lymph nodes. Five patients had tumors located on the left wall of the rectum, and only left-sided lateral pelvic lymph node metastases were observed. The other patient had both sides of lateral pelvic lymph node metastases due to circumferential growth of the tumor around the rectum. Anal preservation was achieved in all patients. The median operating time was 235.0 minutes (range, 210.5-335.5 minutes), and the median estimated blood loss was 50.0 mL (range, 45.0-75.0 mL). Two patients experienced postoperative dysuria and recovered spontaneously within 2-4 months after surgery.On the basis of a prospective case series, we demonstrate, for the first time, the lateral pelvic lymph node metastasis status in patients with rectal neuroendocrine neoplasms requiring radical total mesorectal excision surgery. Simultaneous bilateral lateral pelvic lymph node dissection may be a feasible and beneficial procedure for preventing local recurrence in these patients due to the lack of definitive neoadjuvant or adjuvant therapy options.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.