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

Laparoscopic Versus Open Surgery for Rectal Neuroendocrine Tumors: A Multicenter Real-World Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Laparoscopic Versus Open Surgery for Rectal Neuroendocrine Tumors: A Multicenter Real-World Study Xinyu Zeng, Chengguo Li, Minhao Yu, Rui Zhang, Guole Lin, Maojun Di, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4509547/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 Aug, 2024 Read the published version in BMC Cancer → Version 1 posted 4 You are reading this latest preprint version 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. Neuroendocrine tumors Laparoscopic surgery Open surgery Prognosis Rectum Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Neuroendocrine neoplasms (NENs) are rare neoplasms arising from embryonic neuroendocrine cells and are characterized by neuroendocrine markers. These neoplasms can occur in various organs throughout the body, with the rectum being a common site of incidence (1.04 per 100,000 people) [1, 2] . Based on the Ki-67 index and mitotic count, rectal NENs (RNENs) can be stratified into rectal neuroendocrine tumors (RNETs), rectal neuroendocrine carcinoma (RNEC) and rectal mixed adenoneuroendocrine carcinoma (RMANEC) exhibiting substantial heterogeneity, and tumor grade is a major predictor of metastasis and prognosis in RNENs [3, 4] . Currently, the National Comprehensive Cancer Network (NCCN), the European Neuroendocrine Tumor Society (ENETS) and the Chinese Society of Clinical Oncology (CSCO) guidelines all recommend radical resection for RNETs with risk factors (e.g., tumor size > 2 cm, T stage > T1, lymph node metastasis, muscularis invasion, etc.), RNEC and RMANEC [5–7] . Laparoscopic techniques have been widely used in the treatment of RNETs [8, 9] . However, the outcomes of laparoscopic surgery for RNETs were scarcely described due to their rarity and the even rarer indications of radical surgery. Additionally, comparisons with open surgery are lacking, and surgical option for RNETs remains to be determined. In this study, we collected the diagnosis and treatment data of 17 large tertiary care hospitals in China over a 13-year period to evaluate the efficacy of laparoscopic and open surgery through subgroup analysis of tumor size. MATERIALS AND METHODS Patients and data collection This study retrospectively reviewed the data of patients diagnosed with RNETs at 17 large-scale medical centers in China between January 1, 2010 and April 30, 2022. Demographic, clinicopathologic, treatment, and outcome data were extracted from the electronic medical records of each hospital by surveyors with expertise in NENs, using standardized data collection templates. The inclusion criteria were as follows: (1) confirmation of neuroendocrine tumors by pathology, (2) primary rectal neuroendocrine tumors, and (3) received surgical treatment. The exclusion criteria were as follows: (1) comorbidity with other malignancies, (2) had incomplete clinical data or follow-up information, (3) distant metastasis, (4) underwent local resection, (5) tumor grade of G3, and (6) received neoadjuvant therapy. A total of 174 out of 1459 patients were enrolled in the study. The procedure for identifying eligible study subjects is shown in Fig. 1 . Our work was approved by the Ethics Committees of all 17 participating centers. At the last follow-up, we informed the alive patients about the study in detail and obtained their signed informed consent. For patients who had passed away at the time of the study, we contacted their immediate family members, explained the study in detail, and obtained signed informed consent forms from them. Criteria Tumor size was determined based on the longest diameter of the tumor as recorded in the pathologic reports. Tumor site was divided into low RNETs (≤ 7 cm), median RNETs (7–12 cm), and high RNETs (12–15 cm) according to the distance from the lower edge of the tumor to the anal verge. Tumor stage was classified in accordance with the American Joint Committee on Cancer (AJCC) cancer staging manual, while tumor grade was classified based on the WHO 2010 classification. The mitosis count was expressed as the number of mitotic cells in ten high-power fields from hematoxylin and eosin stained slides examined under microscopy. The Ki-67 index was calculated as the percentage of cells labeled by immunohistochemistry. Complications within 30 days after surgery were recorded and graded according to the Clavien-Dindo classification. Patients with T stage ≥ T2, lymph node metastasis, neurovascular invasion, or tumor size > 2 cm were considered to have a high risk of recurrence, and a multidisciplinary team was involved in formulating adjuvant therapy plans for these patients. For somatostatin receptor-positive patients, somatostatin analog therapy was recommended. Follow-up Relapse-free survival (RFS) was calculated from the date of intervention to the date of recurrence. Follow-up was conducted through telephone, outpatient, or inpatient means. Patients who underwent complete resection were followed every 6 months for the first 5 years, and annually thereafter. The last follow-up was conducted in July 2022. Follow-up examinations consisted of routine blood tests, chromogranin A tests, chest CT scans, and whole abdominal and pelvic contrast-enhanced CT or MRI. PET-CT was performed if recurrence or metastasis was suspected. Loss to follow-up was defined as the failure to contact either the patients or their family members. Statistical analysis Normally distributed quantitative data were presented as means ± standard deviations and were compared using the independent-sample t test; nonnormally distributed quantitative data were presented as medians with interquartile ranges and were compared using the Mann‒Whitney U test. Categorical data were expressed as numbers and percentages, and were analyzed using either the Chi-square test or Fisher’s exact test. RFS was analyzed using the Kaplan-Meier method, and variables were compared using the log-rank test in univariable analysis and Cox proportional hazard regression in multivariable analysis. To minimize the influence of confounding factors, propensity score matching (PSM) was employed [10] . The nearest neighbor matching algorithm was used to match patients based on the logic of the propensity score. A standard deviation less than 10% was considered acceptable for assessing the matching covariate balance [11] , The distribution of propensity scores in both the matched and unmatched groups was assessed using dot plots (Supplemental Fig. 1). Statistical analysis was performed using R software (version 4.0.0). The optimal cut-off value for continuous variables was determined using X-tile software. Variables with a P < 0.10 in the univariate analysis were included in the multivariate analysis. P < 0.05 was considered statistically significant. RESULTS Demographic Data and Clinicopathological Characteristics A total of 174 patients who underwent radical surgery for localized RNETs were included in this study. Among them, 112 (64.4%) were males and 62 (35.6%) were females. The median age was 56 years, with a range of 26 to 83 years. The median tumor size was 2.0 cm, ranging from 0.1 to 7.5 cm. Tumor grade was categorized as G1 in 65 (37.4%) patients and G2 in 109 (62.6%) patients. According to TNM staging, 52 (29.9%) patients were classified as T1, 50 (28.7%) as T2, 56 (32.2%) as T3, and 16 (9.2%) as T4. Lymph node metastasis was clinically positive in 88 (50.6%) patients based on the histopathology results. Sixty (34.5%) patients received adjuvant therapy. The demographic and clinicopathological characteristics of the patients are summarized in Table 1 . Table 1 Comparison of demographic and clinicopathological characteristics before and after propensity score matching Clinicopathological characteristics Overall population (n = 174) Before PSM b After PSM LAP c group (n = 112) OPEN d group (n = 62) P value LAP group (n = 62) OPEN group (n = 62) P value Baseline characteristics Gender, n (%) 0.976 0.704 Female 62 (35.6%) 40 (35.7%) 22 (35.5%) 20 (32.3%) 22 (35.5%) Male 112 (64.4%) 72 (64.3%) 40 (64.5%) 42 (67.7%) 40 (64.5%) Age, n (%), year 0.976 0.579 ≤60 112 (64.4%) 72 (64.3%) 40 (64.5%) 37 (59.7%) 40 (64.5%) >60 62 (35.6%) 40 (35.7%) 22 (35.5%) 25 (40.3%) 22 (35.5%) Tumor size, n (%), cm 0.203 0.342 ≤2 91 (52.3%) 59 (52.7%) 32 (51.6%) 36 (58.1%) 32 (51.6%) 2 ~ 4 57 (32.8%) 40 (35.7%) 17 (27.4%) 19 (30.6%) 17 (27.4%) >4 26 (14.9%) 13 (11.6%) 13 (21.0%) 7 (11.3%) 13 (21.0%) Tumor site, n (%) 0.144 0.713 Low 98 (56.3%) 57 (50.9%) 41 (66.1%) 38 (61.3%) 41 (66.1%) Medium 52 (29.9%) 37 (33.0%) 15 (24.2%) 19 (30.6%) 15 (24.2%) High 24 (13.8%) 18 (16.1%) 6 (9.7%) 5 (8.1%) 6 (9.7%) Tumor grade, n (%) 0.547 0.712 G1 65 (37.4%) 40 (35.7%) 25 (40.3%) 23 (37.1%) 25 (40.3%) G2 109 (62.6%) 72 (64.3%) 37 (59.7%) 39 (62.9%) 37 (59.7%) T stage, n (%) 0.041 0.369 T1 + T2 102 (58.6%) 72 (64.3%) 30 (48.4%) 35 (56.5%) 30 (48.4%) T3 + T4 72 (41.4%) 40 (35.7%) 32 (51.6%) 27 (43.5%) 32 (51.6%) Lymph node metastasis, n (%) 0.074 0.716 Negative 86 (49.4%) 61 (54.5%) 25 (40.3%) 27 (43.5%) 25 (40.3%) Positive 88 (50.6%) 51 (45.5%) 37 (59.7%) 35 (56.5%) 37 (59.7%) Neoadjuvant, n (%) 0.139 1.000 No 158 (90.8%) 99 (88.4%) 59 (95.2%) 59 (95.2%) 59 (95.2%) Yes 16 (9.2%) 13 (11.6%) 3 (4.8%) 3 (4.8%) 3 (4.8%) Adjuvant, n (%) 0.383 0.710 No 114 (65.5%) 76 (67.9%) 38 (61.3%) 40 (64.5%) 38 (61.3%) Yes 60 (34.5%) 36 (32.1%) 24 (38.7%) 22 (35.5%) 24 (38.7%) Surgical outcomes Resection margin, n (%) 0.049 0.133 R0 170 (97.7%) 111 (99.1%) 59 (95.2%) 61 (98.4%) 59 (95.2%) R1 3 (1.7%) 0 (0.0%) 3 (4.8%) 0 (0.0%) 3 (4.8%) R2 1 (0.6%) 1 (0.9%) 0 (0.0%) 1 (1.6%) 0 (0.0%) Operation time, mean ± SD a , min 175.01 ± 68.53 176.63 ± 56.56 172.08 ± 86.52 0.676 174.45 ± 60.82 172.08 ± 86.52 0.860 Complication, n (%) 0.001 0.007 No 137 (78.7%) 97 (86.6%) 40 (64.5%) 53 (85.5%) 40 (64.5%) Yes 37 (21.3%) 15 (13.4%) 22 (35.5%) 9 (14.5%) 22 (35.5%) Postoperative hospital stay, mean ± SD, days 11.09 ± 6.48 10.41 ± 5.56 12.32 ± 7.78 0.062 10.11 ± 5.55 12.32 ± 7.78 0.071 a SD = standard deviation. b PSM = propensity score matching. c LAP = laparoscopic surgery. d OPEN = open surgery. Before PSM, 112 (64.4%) of the patients underwent laparoscopic surgery and 62 (35.6%) underwent open surgery. No significant differences were observed between the groups in terms of gender ( P = 0.976), age ( P = 0.976), tumor size ( P = 0.203), tumor site ( P = 0.144), tumor grade ( P = 0.547), lymph node metastasis ( P = 0.074), neoadjuvant therapy ( P = 0.139), and adjuvant therapy ( P = 0.383); the T stage in the laparoscopic surgery (LAP) group was significantly lower than that in the open surgery (OPEN) group ( P = 0.041). There were no significant differences after matching. The clinicopathologic characteristics of the two groups before and after matching are shown in Table 1 . Surgical Outcomes The operation time and postoperative hospital stay were comparable between the LAP and OPEN groups (176.63 ± 56.56 min vs. 172.08 ± 86.52 min, P = 0.676; 10.41 ± 5.56 days vs. 12.32 ± 7.78 days, P = 0.062). Before PSM, R0 resection rate was greater in the LAP group than in the OPEN group (99.1% vs. 95.2%, P = 0.049). Moreover, the LAP group had a lower incidence of postoperative complications compared to the OPEN group (13.4% vs. 35.5%, P = 0.001). After PSM, there was no significant difference in the R0 resection rate between the two groups (98.4% vs. 95.2%, P = 0.133). However, the LAP group still had a lower postoperative complication rate compared to the OPEN group (14.5% vs. 35.5%, P = 0.007). The surgical outcomes of the two groups before and after matching are shown in Table 1 . Oncologic Outcomes The study had a median follow-up period of 34 (range: 1-123) months. The 1-year, 3-year, and 5-year RFS for RNETs patients who underwent radical surgery were 90.3%, 78.1%, and 76.0%, respectively (Fig. 2 ). The optimal cutoff value for tumor size to predict RFS was determined to be 4.0 cm for two subgroups and 2.0 cm and 4.0 cm for three subgroups. Multivariable analysis revealed that tumor grade (G2: HR: 3.021, 95% CI: 1.145–7.970, P = 0.026) and surgery type (OPEN: HR: 2.043, 95% CI: 1.037–4.025, P = 0.039) were independent risk factors for RFS. Furthermore, in univariate analysis, patients who underwent adjuvant therapy had a significantly lower RFS compared to those who did not undergo adjuvant therapy ( P = 0.001). However, we believe that this difference was caused by patient selection bias, and thus this factor was not included in the multivariate analysis. Log-rank test and Cox proportional hazard regression analysis of RFS are shown in Table 2 . Table 2 Univariate and multivariate relapse-free survival analysis Clinicopathological factors Univariate analysis Multivariable analysis HR c 95% CI d P value HR 95% CI P value Gender (Male/Female) 1.082 0.538–2.178 0.825 Age (> 65/≤65) 0.635 0.315–1.279 0.204 Tumor site 0.508 Low Medium 0.638 0.298–1.370 0.249 High 0.792 0.297–2.115 0.642 Tumor size, cm 0.235 ≤2 2 ~ 4 1.827 0.853–3.912 0.121 >4 2.018 0.658–6.192 0.220 Tumor grade (G2/G1) 3.006 1.200-7.532 0.019 3.021 1.145–7.970 0.026 Surgery (OPEN a /LAP b ) 2.050 1.015–4.140 0.045 2.043 1.037–4.025 0.039 Adjuvant (Yes /No) 3.335 1.602–6.943 0.001 a OPEN = open surgery. b LAP = laparoscopic surgery. c HR = hazard ratio. d CI = confidence interval. Before PSM, the 1-year, 3-year, and 5-year RFS were 93.6%, 83.2%, and 81.4% in the LAP group and 84.3%, 69.8%, and 67.4% in the OPEN group, the difference was statistically significant ( P = 0.045). After PSM, the 1-year, 3-year, and 5-year RFS were 95.2%, 85.3%, and 85.3% in the LAP group and 84.3%, 69.8%, and 67.4% in the OPEN group, the difference was also statistically significant ( P = 0.048). The survival curves according to surgical type before and after PSM were shown in Fig. 3 A- 3 B. Subgroup Analysis Tumor size has a great correlation with surgical resection difficulty; thus, we carried out a subgroup analysis based on this factor. In the aforementioned prognostic analysis, we found that the optimal cutoff value of tumor size for predicting RFS was 4.0 cm. In the RNETs ≤ 4 cm subgroup, there were 49 patients in the LAP group and 55 patients in the OPEN group, while in the RNETs > 4 cm subgroup, there were 13 patients in the LAP group and 7 patients in the OPEN group. No significant differences were observed in terms of baseline characteristics. There were no significant differences in the R0 resection rate or operation time in either the RNETs ≤ 4 cm subgroup (100.0% vs. 95.9%, P = 0.220; 175.29 ± 63.16 min vs. 170.63 ± 92.01 min, P = 0.762) or the RNETs > 4 cm subgroup (85.7% vs. 92.3%, P = 0.299; 167.86 ± 40.50 min vs. 177.54 ± 64.41 min, P = 0.724). The LAP group had a lower incidence of postoperative complications than the OPEN group in the RNETs ≤ 4 cm subgroup (10.9% vs. 34.7%, P = 0.004), while no significant difference was observed in the RNETs > 4 cm subgroup (42.9% vs. 38.5%, P = 1.000). Similarly, the postoperative hospital stay in the LAP group was significantly shorter than that in the OPEN group in the RNETs ≤ 4 cm subgroup (9.56 ± 5.21 days vs. 12.31 ± 8.61 days, P = 0.049), while no significant difference was observed in the RNETs > 4 cm subgroup (14.43 ± 6.60 days vs. 12.38 ± 3.33 days, P = 0.465). The clinicopathologic characteristics and surgical outcomes of the subgroups are shown in Table 3 . Table 3 Comparison of demographic and clinicopathological characteristics in subgroup analysis of tumor size after propensity score matching Clinicopathological characteristics ≤ 4cm > 4cm LAP b group (n = 55) OPEN c group (n = 49) P value LAP group (n = 7) OPEN group (n = 13) P value Baseline characteristics Gender, n (%) 0.849 1.000 Female 17 (30.9%) 16 (32.7%) 3 (42.9%) 6 (46.2%) Male 38 (69.1%) 33 (67.3%) 4 (57.1%) 7 (53.8%) Age, n (%), year 0.557 1.000 ≤60 34 (61.8%) 33 (67.3%) 3 (42.9%) 7 (53.8%) >60 21 (38.2%) 16 (32.7%) 4 (57.1%) 6 (46.2%) Tumor site, n (%) 0.952 0.386 Low 35 (63.6%) 32 (65.3%) 3 (42.9%) 9 (69.2%) Medium 16 (29.1%) 13 (26.5%) 3 (42.9%) 2 (15.4%) High 4 (7.3%) 4 (8.2%) 1 (14.3%) 2 (15.4%) Tumor grade, n (%) 0.357 1.000 G1 22 (40.0%) 24 (49.0%) 1 (14.3%) 1 (7.7%) G2 33 (60.0%) 25 (51.0%) 6 (85.7%) 12 (92.7%) T stage, n (%) 0.784 1.000 T1 + T2 34 (61.8%) 29 (59.2%) 1 (14.3%) 1 (7.7%) T3 + T4 21 (38.2%) 20 (40.8%) 6 (85.7%) 12 (92.3%) Lymph node metastasis, n (%) 0.585 0.197 Negative 24 (43.6%) 24 (49.0%) 3 (42.9%) 1 (7.7%) Positive 31 (56.4%) 25 (51.0%) 4 (57.1%) 12 (92.3%) Adjuvant, n (%) 0.668 1.000 No 37 (67.3%) 31 (63.3%) 3 (42.9%) 7 (53.8%) Yes 18 (32.7%) 18 (36.7%) 4 (57.1%) 6 (46.2%) Surgical outcomes Resection margin, n (%) 0.220 0.299 R0 55 (100.0%) 47 (95.9%) 6 (85.7%) 12 (92.3%) R1 0 (0.0%) 2 (4.1%) 0 (0.0%) 1 (7.7%) R2 0 (0.0%) 0 (0.0%) 1 (14.3%) 0 (0.0%) Operation time, mean ± SD a , min 175.29 ± 63.16 170.63 ± 92.01 0.762 167.86 ± 40.50 177.54 ± 64.41 0.724 Complication, n (%) 0.004 1.000 No 49 (89.1%) 32 (65.3%) 4 (57.1%) 8 (61.5%) Yes 6 (10.9%) 17 (34.7%) 3 (42.9%) 5 (38.5%) Postoperative hospital stay, mean ± SD, days 9.56 ± 5.21 12.31 ± 8.61 0.049 14.43 ± 6.60 12.38 ± 3.33 0.465 a SD = standard deviation. b LAP = laparoscopic surgery. c OPEN = open surgery. The RFS of the LAP group was superior than that of the OPEN group in the RNETs ≤ 4 cm subgroup ( P = 0.025), while no significant difference was found in the RNETs > 4 cm subgroup ( P = 0.724). The survival curves according to surgical type are shown in Fig. 3 C- 3 D. DISCUSSION Radical resection, which includes low anterior resection and abdominoperineal resection, is the primary treatment for localized RNETs. However, while radical resection achieves a more complete tumor dissection and improves patient survival, it may also result in poor functional outcomes compared to local excision [12–16] . Therefore, the choice between local excision and radical resection is crucial in managing patients with RNETs. In this study, preoperative imaging results serve as important references for selecting surgical methods for RNETs patients. By effectively communicating with patients and their families, we determined the optimal surgical approach after carefully assessing tumor size, tumor grade, T stage, and lymph node metastasis status. For RNETs, we recommended radical resection for patients with tumor size > 2 cm, T stage > T1, lymph node metastasis, or muscularis invasion. For patients with RNEC and RMANEC, radical resection was suggested. These indications for radical resection are similar to those outlined in the CSCO guidelines for RNENs [5] . Laparoscopic surgery has become the standard treatment recommendation for digestive tract tumor surgery. Several retrospective case-control studies and randomized controlled trials have demonstrated that laparoscopic surgery has a long-term prognosis not inferior to that of open surgery, and has the advantages of less trauma and rapid postoperative recovery [17–20] . However, evidence comparing laparoscopic surgery and open surgery for RNETs has scarcely been described due to their rarity and the even rarer indications for radical surgery. Therefore, we designed and implemented the multicenter study to compare postoperative and oncological outcomes between laparoscopic surgery and open surgery for RNETs. To the best of our knowledge, this is currently the largest study of RNETs in patients who underwent radical resection. RNETs are located in the pelvic cavity, with complex adjacent organs and narrow surgical space, making precise localization and safe resection difficult. Laparoscopic surgery can effectively reduce traction injury to the surrounding organs by directly reaching the lesion site with extended surgical instruments; Meanwhile, image reproduction is achieved through the endoscope and monitor, which makes it possible for surgeons to observe the surgical field more intuitively, assisting in safe tumor resection. Studies have shown that laparoscopic surgery for NENs in the stomach and small bowel yields short-term outcomes comparable to those of open surgery [21, 22] . In this study, we found that laparoscopic surgery for RNETs resulted in a lower incidence of complications and a higher rate of R0 resection compared to open surgery. To improve the credibility of our retrospective data analysis, we performed PSM between the groups to balance the covariates and confounders. After PSM, we still found a lower incidence of postoperative complications in the LAP group, with no significant differences in the R0 resection rate, operation time, or postoperative hospital stay. These results demonstrate that laparoscopic surgery may offer better surgical outcomes for RNETs due to its minimally invasive nature. Although laparoscopic surgery lacks tactile sensation, which poses a risk of tumor rupture and iatrogenic dissemination, studies have shown satisfactory long-term prognosis in laparoscopic resection of RNETs, with a 3-year overall survival rate of 97.8% [8, 9] . However, comparisons of laparoscopic and open surgery in terms of oncological outcomes for RNETs are still lacking. In our study, we used the PSM method to minimize the influence of confounding factors. The results suggested that laparoscopic surgery was associated with better RFS than open surgery group before and after PSM. Taken together, we conclude that laparoscopic surgery can serve as a safe and feasible option for radical surgery of RNETs. Tumor size is associated with surgical resection difficulty during the treatment of digestive tract tumors, and a larger tumor size often indicates more complicated surgical procedures, which increases the risk of intraoperative complications. To assess the impact of tumor size on short-term and long-term outcomes, we performed a subgroup analysis of patients with RNETs after PSM using a cutoff of 4 cm. Among patients with RNETs ≤ 4 cm, those in the laparoscopic group had fewer complications, shorter postoperative hospital stays, and superior RFS compared with those in the open group, whereas among patients with RNETs > 4 cm, the short-term and long-term outcomes did not significantly differ between the laparoscopic group and the open group. Similarly, previous studies at our medical center have shown that in rectal gastrointestinal stromal tumors, laparoscopic surgery is associated with superior RFS and fewer complications only in patients ≤ 5 cm, whereas these advantages were lost in patients in the > 5 cm group [23] . These results may suggest that laparoscopic surgery has advantages related to tumor size in the management of rectal neoplasms. This study has several limitations. First, although we used PSM to reduce potential bias and performed subgroup analysis to investigate the impact of surgical approach on patient outcomes, the retrospective nature of the study still affects its statistical power and clinical value. In addition, RNETs are slow-growing tumors [24] , and a longer follow-up period is required for a comprehensive clinical evaluation of patient status. However, to the best of our knowledge, this is currently the largest study comparing laparoscopic surgery with open surgery for RNETs and can provide valuable guidance for their treatment. CONCLUSION In summary, laparoscopic surgery is a safe and feasible option for the radical resection of localized RNETs. For patients with RNETs ≤ 4 cm, laparoscopic surgery was associated with a superior RFS, a reduced rate of complications, and shorter postoperative hospital stays, whereas the R0 resection rate and operation time were comparable to those of open surgery. For patients with RNETs > 4 cm, laparoscopic surgery has oncologic and surgical outcomes similar to those of open surgery. Abbreviations AJCC: American Joint Committee on Cancer CSCO: Chinese Society of Clinical Oncology ENETS: European Neuroendocrine Tumor Society NCCN: National Comprehensive Cancer Network NENs: Neuroendocrine neoplasms PSM: Propensity score matching RFS: Relapse-free survival RMANEC: Rectal mixed adenoneuroendocrine carcinoma RNEC: Rectal neuroendocrine carcinoma RNENs: Rectal neuroendocrine neoplasms RNETs: Rectal neuroendocrine tumors Declarations Acknowledgments: Not applicable. Author Contributions: Weizhong Jiang and Kaixiong Tao had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Chengguo Li, Weizhong Jiang, Kaixiong Tao. Acquisition, analysis, or interpretation of data: Xinyu Zeng, Chengguo Li, Minhao Yu, Rui Zhang, Guole Lin, Maojun Di, Hongxue Wu, Yueming Sun, Zhiguo Xiong, Congqing Jiang, Bin Yu, Shengning Zhou, Yong Li, Xiaofeng Liao, Lijian Xia, Wei Zhang. Drafting of the manuscript: Xinyu Zeng, Chengguo Li. Critical revision of the manuscript for important intellectual content: Minhao Yu, Rui Zhang, Guole Lin, Maojun Di, Hongxue Wu, Yueming Sun, Zhiguo Xiong, Congqing Jiang, Bin Yu, Shengning Zhou, Yong Li, Xiaofeng Liao, Lijian Xia, Wei Zhang, Weizhong Jiang, Kaixiong Tao. Statistical analysis: Minhao Yu, Rui Zhang, Guole Lin, Maojun Di, Hongxue Wu, Yueming Sun. Administrative, technical, or material support: Zhiguo Xiong, Congqing Jiang, Bin Yu, Shengning Zhou, Yong Li, Xiaofeng Liao, Lijian Xia, Wei Zhang, Weizhong Jiang, Kaixiong Tao. Supervision: Weizhong Jiang, Kaixiong Tao. Funding: This study was funded by the National Natural Science Foundation of China (Grant No. 81702386 and 81874184), and the Key Project of Hubei Health Commission (Grant No.WJ2019Q030). Availability of data and materials: The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate: This study conforms to the Declaration of Helsinki. Our work was approved by the Ethics Committee of all 17 participating centers. At the last follow-up, we informed the alive patients about the study in detail and obtained the informed consent signed by them. For patients who were not alive at the time of the study, we contacted their immediate family members, explained the study in detail and obtained the informed consent forms signed by them. Competing interests: The authors declare no competing interests. References Dasari A, Shen C, Halperin D, et al. Trends in the Incidence, Prevalence, and Survival Outcomes in Patients With Neuroendocrine Tumors in the United States. JAMA Oncol. 2017;3(10):1335-1342. Cives M, Strosberg JR. Gastroenteropancreatic Neuroendocrine Tumors. CA Cancer J Clin. 2018;68(6):471-487. Ramage JK, Ahmed A, Ardill J, et al. Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours (NETs). Gut. 2012;61(1):6-32. Anthony LB, Strosberg JR, Klimstra DS, et al. The NANETS consensus guidelines for the diagnosis and management of gastrointestinal neuroendocrine tumors (nets): well-differentiated nets of the distal colon and rectum. Pancreas. 2010;39(6):767-774. Li YW, He YP, Liu FQ, et al. Grade G2 Rectal Neuroendocrine Tumor Is Much More Invasive Compared With G1 Tumor. Front Oncol. 2021;11:646536. Ramage JK, De Herder WW, Delle Fave G, et al. ENETS Consensus Guidelines Update for Colorectal Neuroendocrine Neoplasms. Neuroendocrinology. 2016;103(2):139-143. Shah MH, Goldner WS, Benson AB, et al. Neuroendocrine and Adrenal Tumors, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021;19(7):839-868. Takatsu Y, Fukunaga Y, Nagasaki T, et al. Short- and Long-term Outcomes of Laparoscopic Total Mesenteric Excision for Neuroendocrine Tumors of the Rectum. Dis Colon Rectum. 2017;60(3):284-289. Inoue T, Nakagawa T, Nakamura S, et al. Laparoscopic surgery after endoscopic resection for rectal cancer and neuroendocrine tumors. Surg Endosc. 2015;29(6):1506-1511. D'Agostino RB Jr. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998;17(19):2265-2281. <DOI: 10.1002/(sici)1097-0258(19981015)17:193.0.co;2-b> Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009;28(25):3083-3107. Caulfield H, Hyman NH. Anastomotic leak after low anterior resection: a spectrum of clinical entities. JAMA Surg. 2013;148(2):177-182. Phillips BR, Harris LJ, Maxwell PJ, Isenberg GA, Goldstein SD. Anastomotic leak rate after low anterior resection for rectal cancer after chemoradiation therapy. Am Surg. 2010;76(8):869-871.[J]. Bryant CL, Lunniss PJ, Knowles CH, Thaha MA, Chan CL. Anterior resection syndrome. Lancet Oncol. 2012;13(9):e403-e408. Pucciani F. A review on functional results of sphincter-saving surgery for rectal cancer: the anterior resection syndrome. Updates Surg. 2013;65(4):257-263. Emmertsen KJ, Laurberg S. Bowel dysfunction after treatment for rectal cancer. Acta Oncol. 2008;47(6):994-1003. de Mestier L, Lorenzo D, Fine C, et al. Endoscopic, transanal, laparoscopic, and transabdominal management of rectal neuroendocrine tumors. Best Pract Res Clin Endocrinol Metab. 2019;33(5):101293. Li K, Liu Y, Han J, Gui J, Zhang X. The genetic alterations of rectal neuroendocrine tumor and indications for therapy and prognosis: a systematic review. Endocr J. 2023;70(2):197-205. Gallo C, Rossi RE, Cavalcoli F, et al. Rectal neuroendocrine tumors: Current advances in management, treatment, and surveillance. World J Gastroenterol. 2022;28(11):1123-1138. Sekiguchi M, Matsuda T, Saito Y. Treatment strategy and post-treatment management of colorectal neuroendocrine tumor. DEN Open. 2023;4(1):e254. Zhao YJ, Zhuang LP, Liu YY, et al. Comparative study of laparoscopic versus open radical gastrectomy in advanced gastric neuroendocrine carcinoma: Analysis from a high-volume institution. Asian J Surg. 2020;43(3):488-496. Kaçmaz E, van Eeden S, Koppes JCC, et al. Value of Laparoscopy for Resection of Small-Bowel Neuroendocrine Neoplasms Including Central Mesenteric Lymphadenectomy. Dis Colon Rectum. 2021;64(10):1240-1248. Jia J, Wang M, Lin G, et al. Laparoscopic Versus Open Surgery for Rectal Gastrointestinal Stromal Tumor: A Multicenter Propensity Score-Matched Analysis. Dis Colon Rectum. 2022;65(4):519-528. Nam SJ, Kim BC, Chang HJ, Jeon HH, Kim J, Kim SY. Risk Factors for Lymph Node Metastasis and Oncologic Outcomes in Small Rectal Neuroendocrine Tumors with Lymphovascular Invasion. Gut Liver. 2022;16(2):228-235. Additional Declarations No competing interests reported. Supplementary Files SupplementalFigure1.tiff Supplemental Figure 1. Dot plots of the distribution of propensity score in both matched and unmatched groups. Cite Share Download PDF Status: Published Journal Publication published 05 Aug, 2024 Read the published version in BMC Cancer → Version 1 posted Editorial decision: Revision requested 04 Jun, 2024 Editor assigned by journal 04 Jun, 2024 Submission checks completed at journal 03 Jun, 2024 First submitted to journal 31 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4509547","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":310536308,"identity":"14527009-8154-4d80-9841-17ce5527a876","order_by":0,"name":"Xinyu Zeng","email":"","orcid":"","institution":"Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xinyu","middleName":"","lastName":"Zeng","suffix":""},{"id":310536309,"identity":"1e1cdee9-bff9-4fa5-942b-0f1554d8dfa1","order_by":1,"name":"Chengguo Li","email":"","orcid":"","institution":"Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Chengguo","middleName":"","lastName":"Li","suffix":""},{"id":310536310,"identity":"6cb38ea9-f31d-4530-a7b5-fee841240327","order_by":2,"name":"Minhao Yu","email":"","orcid":"","institution":"Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Minhao","middleName":"","lastName":"Yu","suffix":""},{"id":310536311,"identity":"853ac152-013c-4a84-a350-57c0f0621b48","order_by":3,"name":"Rui Zhang","email":"","orcid":"","institution":"Department of Colorectal Cancer, Liaoning Cancer Hospital \u0026 Institute, Shenyang","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rui","middleName":"","lastName":"Zhang","suffix":""},{"id":310536312,"identity":"241ce172-6bd6-4023-a012-93ff2fe2ba44","order_by":4,"name":"Guole Lin","email":"","orcid":"","institution":"Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Guole","middleName":"","lastName":"Lin","suffix":""},{"id":310536313,"identity":"f086f38c-bb2d-4c6d-9a4c-875a327384c0","order_by":5,"name":"Maojun Di","email":"","orcid":"","institution":"Department of Gastrointestinal Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Maojun","middleName":"","lastName":"Di","suffix":""},{"id":310536314,"identity":"ae1fb3ed-a074-46b6-899d-ceafebcd2c9a","order_by":6,"name":"Hongxue Wu","email":"","orcid":"","institution":"Department of Gastrointestinal Surgery I Section, Renmin Hospital of Wuhan University, Wuhan","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hongxue","middleName":"","lastName":"Wu","suffix":""},{"id":310536315,"identity":"91d9d5e5-f16d-4b24-b31d-378b99935aea","order_by":7,"name":"Yueming Sun","email":"","orcid":"","institution":"Department of Colorectal Surgery, Jiangsu Province Hospital, Nanjing Medical University. Nanjing","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yueming","middleName":"","lastName":"Sun","suffix":""},{"id":310536316,"identity":"bd5e9d65-1c43-4807-ac71-a43590eca6b5","order_by":8,"name":"Zhiguo Xiong","email":"","orcid":"","institution":"Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhiguo","middleName":"","lastName":"Xiong","suffix":""},{"id":310536317,"identity":"b629728c-782c-453c-8f47-88c128fcd4ad","order_by":9,"name":"Congqing Jiang","email":"","orcid":"","institution":"Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Congqing","middleName":"","lastName":"Jiang","suffix":""},{"id":310536318,"identity":"c42adc46-4984-434f-abc8-46d55d6fa4f8","order_by":10,"name":"Bin Yu","email":"","orcid":"","institution":"Department of General Surgery, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bin","middleName":"","lastName":"Yu","suffix":""},{"id":310536319,"identity":"82f0a5fb-4c0b-43b7-91ab-25a11ef817d2","order_by":11,"name":"Shengning Zhou","email":"","orcid":"","institution":"Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. Guangzhou","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shengning","middleName":"","lastName":"Zhou","suffix":""},{"id":310536320,"identity":"8c171852-b9b9-4d88-9a34-cab7b4dc6650","order_by":12,"name":"Yong Li","email":"","orcid":"","institution":"Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yong","middleName":"","lastName":"Li","suffix":""},{"id":310536321,"identity":"a3923454-de3d-4ee9-86bf-5e942a0e59c1","order_by":13,"name":"Xiaofeng Liao","email":"","orcid":"","institution":"Department of General Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiaofeng","middleName":"","lastName":"Liao","suffix":""},{"id":310536322,"identity":"b826556a-5080-4827-8755-6cfe81324545","order_by":14,"name":"Lijian Xia","email":"","orcid":"","institution":"Department of Colorectal and Anal Surgery, the First Affiliated Hospital of Shandong First Medical University, Jinan","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lijian","middleName":"","lastName":"Xia","suffix":""},{"id":310536323,"identity":"f71446ce-f128-4d0e-9ebb-33d835adad54","order_by":15,"name":"Wei Zhang","email":"","orcid":"","institution":"Department of Colorectal Surgery, Shanghai Changhai Hospital, Naval Medical University. Shanghai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Zhang","suffix":""},{"id":310536324,"identity":"d207b4bc-c0f7-4560-bda9-41a1e69da9cb","order_by":16,"name":"Weizhong Jiang","email":"","orcid":"","institution":"Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Weizhong","middleName":"","lastName":"Jiang","suffix":""},{"id":310536325,"identity":"4717146f-18a3-4176-87fa-a4de166bec55","order_by":17,"name":"kaixiong tao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIiWNgGAWjYBACCQbGBoYECJvxMVTQgDgtPAwMzMZgAcJaoACohU2aKC2S7YfbJB5U3LHbz374WHVhW10dA3vzNgmGmjs4tUjzJDYbJJx5ltzDk5Z2e2bbYQkGnmNlEgzHnuHUIseQ2Pggse1wMg9Djtlt3rYDEgwSOWYSjA2HcWvhf9hwAKyF/41ZMW9bnQSD/Bv8WqQlILbY8QANZ+ZtYwbawoNfi+SMhyC/HE7gufEsWZrn3GHJNp60YouEY7i1SJxPfyb5o+KwPXt/8sHPPGV1/Pzshzfe+FCDWwsMJDbAWGwgIoGgBgYGeyLUjIJRMApGwUgFAM7lT3VWBl+9AAAAAElFTkSuQmCC","orcid":"","institution":"Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"kaixiong","middleName":"","lastName":"tao","suffix":""}],"badges":[],"createdAt":"2024-05-31 14:15:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4509547/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4509547/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12885-024-12711-x","type":"published","date":"2024-08-05T15:57:43+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":58609451,"identity":"8097c149-4d15-4299-83ab-c021b77fe65c","added_by":"auto","created_at":"2024-06-18 21:56:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":213815,"visible":true,"origin":"","legend":"\u003cp\u003ePatient selection flowchart.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4509547/v1/50adb10d05666b06327d22c8.png"},{"id":58609454,"identity":"41b66bcb-c32c-465f-b6b7-6ca9bfc56386","added_by":"auto","created_at":"2024-06-18 21:56:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":84732,"visible":true,"origin":"","legend":"\u003cp\u003eRelapse-free survival curve of the entire cohort of 174 rectal neuroendocrine tumors patients.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4509547/v1/96926b952236fc49c3870a2d.png"},{"id":58609455,"identity":"c3ce50c5-5c86-46c8-b19e-fae351e3b7fd","added_by":"auto","created_at":"2024-06-18 21:56:26","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":429680,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of relapse-free survival between the laparoscopic surgery group and open surgery group: (A) Before propensity score matching; (B) After propensity score matching; (C) ≤ 4 cm subgroup after propensity score matching; (D) \u0026gt; 4 cm subgroup after propensity score matching.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-4509547/v1/3e34fbc67f4288f176a9b4e2.png"},{"id":62298437,"identity":"01f93d74-79e4-4d8a-aa9a-29e7000212b1","added_by":"auto","created_at":"2024-08-12 16:13:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1775361,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4509547/v1/4c18a109-6cbc-4c61-9ec3-744c9dd3fd6c.pdf"},{"id":58609453,"identity":"21879587-6c62-477c-bed6-a1725e4ea277","added_by":"auto","created_at":"2024-06-18 21:56:26","extension":"tiff","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":957192,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplemental Figure 1.\u003c/strong\u003e Dot plots of the distribution of propensity score in both matched and unmatched groups.\u003c/p\u003e","description":"","filename":"SupplementalFigure1.tiff","url":"https://assets-eu.researchsquare.com/files/rs-4509547/v1/ec6c109af9b8b910867edb2a.tiff"}],"financialInterests":"No competing interests reported.","formattedTitle":"Laparoscopic Versus Open Surgery for Rectal Neuroendocrine Tumors: A Multicenter Real-World Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eNeuroendocrine neoplasms (NENs) are rare neoplasms arising from embryonic neuroendocrine cells and are characterized by neuroendocrine markers. These neoplasms can occur in various organs throughout the body, with the rectum being a common site of incidence (1.04 per 100,000 people)\u003csup\u003e[1, 2]\u003c/sup\u003e. Based on the Ki-67 index and mitotic count, rectal NENs (RNENs) can be stratified into rectal neuroendocrine tumors (RNETs), rectal neuroendocrine carcinoma (RNEC) and rectal mixed adenoneuroendocrine carcinoma (RMANEC) exhibiting substantial heterogeneity, and tumor grade is a major predictor of metastasis and prognosis in RNENs\u003csup\u003e[3, 4]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eCurrently, the National Comprehensive Cancer Network (NCCN), the European Neuroendocrine Tumor Society (ENETS) and the Chinese Society of Clinical Oncology (CSCO) guidelines all recommend radical resection for RNETs with risk factors (e.g., tumor size\u0026thinsp;\u0026gt;\u0026thinsp;2 cm, T stage\u0026thinsp;\u0026gt;\u0026thinsp;T1, lymph node metastasis, muscularis invasion, etc.), RNEC and RMANEC\u003csup\u003e[5\u0026ndash;7]\u003c/sup\u003e. Laparoscopic techniques have been widely used in the treatment of RNETs\u003csup\u003e[8, 9]\u003c/sup\u003e. However, the outcomes of laparoscopic surgery for RNETs were scarcely described due to their rarity and the even rarer indications of radical surgery. Additionally, comparisons with open surgery are lacking, and surgical option for RNETs remains to be determined.\u003c/p\u003e \u003cp\u003eIn this study, we collected the diagnosis and treatment data of 17 large tertiary care hospitals in China over a 13-year period to evaluate the efficacy of laparoscopic and open surgery through subgroup analysis of tumor size.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients and data collection\u003c/h2\u003e \u003cp\u003eThis study retrospectively reviewed the data of patients diagnosed with RNETs at 17 large-scale medical centers in China between January 1, 2010 and April 30, 2022. Demographic, clinicopathologic, treatment, and outcome data were extracted from the electronic medical records of each hospital by surveyors with expertise in NENs, using standardized data collection templates. The inclusion criteria were as follows: (1) confirmation of neuroendocrine tumors by pathology, (2) primary rectal neuroendocrine tumors, and (3) received surgical treatment. The exclusion criteria were as follows: (1) comorbidity with other malignancies, (2) had incomplete clinical data or follow-up information, (3) distant metastasis, (4) underwent local resection, (5) tumor grade of G3, and (6) received neoadjuvant therapy. A total of 174 out of 1459 patients were enrolled in the study. The procedure for identifying eligible study subjects is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Our work was approved by the Ethics Committees of all 17 participating centers. At the last follow-up, we informed the alive patients about the study in detail and obtained their signed informed consent. For patients who had passed away at the time of the study, we contacted their immediate family members, explained the study in detail, and obtained signed informed consent forms from them.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eCriteria\u003c/h2\u003e \u003cp\u003eTumor size was determined based on the longest diameter of the tumor as recorded in the pathologic reports. Tumor site was divided into low RNETs (\u0026le;\u0026thinsp;7 cm), median RNETs (7\u0026ndash;12 cm), and high RNETs (12\u0026ndash;15 cm) according to the distance from the lower edge of the tumor to the anal verge. Tumor stage was classified in accordance with the American Joint Committee on Cancer (AJCC) cancer staging manual, while tumor grade was classified based on the WHO 2010 classification. The mitosis count was expressed as the number of mitotic cells in ten high-power fields from hematoxylin and eosin stained slides examined under microscopy. The Ki-67 index was calculated as the percentage of cells labeled by immunohistochemistry. Complications within 30 days after surgery were recorded and graded according to the Clavien-Dindo classification. Patients with T stage\u0026thinsp;\u0026ge;\u0026thinsp;T2, lymph node metastasis, neurovascular invasion, or tumor size\u0026thinsp;\u0026gt;\u0026thinsp;2 cm were considered to have a high risk of recurrence, and a multidisciplinary team was involved in formulating adjuvant therapy plans for these patients. For somatostatin receptor-positive patients, somatostatin analog therapy was recommended.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eFollow-up\u003c/h2\u003e \u003cp\u003eRelapse-free survival (RFS) was calculated from the date of intervention to the date of recurrence. Follow-up was conducted through telephone, outpatient, or inpatient means. Patients who underwent complete resection were followed every 6 months for the first 5 years, and annually thereafter. The last follow-up was conducted in July 2022. Follow-up examinations consisted of routine blood tests, chromogranin A tests, chest CT scans, and whole abdominal and pelvic contrast-enhanced CT or MRI. PET-CT was performed if recurrence or metastasis was suspected. Loss to follow-up was defined as the failure to contact either the patients or their family members.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eNormally distributed quantitative data were presented as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations and were compared using the independent-sample t test; nonnormally distributed quantitative data were presented as medians with interquartile ranges and were compared using the Mann‒Whitney U test. Categorical data were expressed as numbers and percentages, and were analyzed using either the Chi-square test or Fisher\u0026rsquo;s exact test. RFS was analyzed using the Kaplan-Meier method, and variables were compared using the log-rank test in univariable analysis and Cox proportional hazard regression in multivariable analysis. To minimize the influence of confounding factors, propensity score matching (PSM) was employed\u003csup\u003e[10]\u003c/sup\u003e. The nearest neighbor matching algorithm was used to match patients based on the logic of the propensity score. A standard deviation less than 10% was considered acceptable for assessing the matching covariate balance\u003csup\u003e[11]\u003c/sup\u003e, The distribution of propensity scores in both the matched and unmatched groups was assessed using dot plots (Supplemental Fig.\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eStatistical analysis was performed using R software (version 4.0.0). The optimal cut-off value for continuous variables was determined using X-tile software. Variables with a \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.10 in the univariate analysis were included in the multivariate analysis. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Data and Clinicopathological Characteristics\u003c/h2\u003e \u003cp\u003eA total of 174 patients who underwent radical surgery for localized RNETs were included in this study. Among them, 112 (64.4%) were males and 62 (35.6%) were females. The median age was 56 years, with a range of 26 to 83 years. The median tumor size was 2.0 cm, ranging from 0.1 to 7.5 cm. Tumor grade was categorized as G1 in 65 (37.4%) patients and G2 in 109 (62.6%) patients. According to TNM staging, 52 (29.9%) patients were classified as T1, 50 (28.7%) as T2, 56 (32.2%) as T3, and 16 (9.2%) as T4. Lymph node metastasis was clinically positive in 88 (50.6%) patients based on the histopathology results. Sixty (34.5%) patients received adjuvant therapy. The demographic and clinicopathological characteristics of the patients are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of demographic and clinicopathological characteristics before and after propensity score matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eClinicopathological\u003c/p\u003e \u003cp\u003echaracteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOverall population\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;174)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eBefore PSM\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eAfter PSM\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLAP\u003csup\u003ec\u003c/sup\u003e group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;112)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOPEN\u003csup\u003ed\u003c/sup\u003e group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLAP group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOPEN group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBaseline characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.976\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.704\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (35.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (35.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (35.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20 (32.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22 (35.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112 (64.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (64.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (64.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42 (67.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40 (64.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, n (%), year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.976\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.579\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112 (64.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (64.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (64.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37 (59.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40 (64.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (35.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (35.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (35.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25 (40.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22 (35.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor size, n (%), cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.203\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91 (52.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (52.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (51.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36 (58.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e32 (51.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026thinsp;~\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57 (32.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (35.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (27.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (30.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17 (27.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (14.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (21.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (11.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13 (21.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor site, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.713\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98 (56.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (50.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (66.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38 (61.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e41 (66.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (29.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (33.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (24.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (30.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15 (24.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (13.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (16.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (8.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor grade, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.547\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.712\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (37.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (35.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (40.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23 (37.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25 (40.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109 (62.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (64.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (59.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39 (62.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e37 (59.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT stage, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.041\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.369\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1\u0026thinsp;+\u0026thinsp;T2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102 (58.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (64.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (48.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35 (56.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30 (48.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT3\u0026thinsp;+\u0026thinsp;T4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72 (41.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (35.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (51.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27 (43.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e32 (51.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymph node metastasis, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.716\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86 (49.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (54.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (40.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27 (43.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25 (40.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88 (50.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (45.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (59.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35 (56.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e37 (59.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeoadjuvant, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e158 (90.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99 (88.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (95.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e59 (95.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e59 (95.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (9.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdjuvant, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.710\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114 (65.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76 (67.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (61.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40 (64.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e38 (61.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (34.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (32.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (38.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 (35.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24 (38.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgical outcomes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResection margin, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.049\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e170 (97.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111 (99.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (95.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61 (98.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e59 (95.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation time, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003csup\u003ea\u003c/sup\u003e, min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e175.01\u0026thinsp;\u0026plusmn;\u0026thinsp;68.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e176.63\u0026thinsp;\u0026plusmn;\u0026thinsp;56.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e172.08\u0026thinsp;\u0026plusmn;\u0026thinsp;86.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e174.45\u0026thinsp;\u0026plusmn;\u0026thinsp;60.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e172.08\u0026thinsp;\u0026plusmn;\u0026thinsp;86.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.860\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplication, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137 (78.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97 (86.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (64.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e53 (85.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40 (64.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (21.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (13.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (35.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (14.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22 (35.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative hospital stay, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.09\u0026thinsp;\u0026plusmn;\u0026thinsp;6.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.41\u0026thinsp;\u0026plusmn;\u0026thinsp;5.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.32\u0026thinsp;\u0026plusmn;\u0026thinsp;7.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.11\u0026thinsp;\u0026plusmn;\u0026thinsp;5.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12.32\u0026thinsp;\u0026plusmn;\u0026thinsp;7.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003ea\u003c/sup\u003eSD = standard deviation. \u003csup\u003eb\u003c/sup\u003ePSM = propensity score matching. \u003csup\u003ec\u003c/sup\u003eLAP = laparoscopic surgery. \u003csup\u003ed\u003c/sup\u003eOPEN = open surgery.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBefore PSM, 112 (64.4%) of the patients underwent laparoscopic surgery and 62 (35.6%) underwent open surgery. No significant differences were observed between the groups in terms of gender (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.976), age (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.976), tumor size (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.203), tumor site (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.144), tumor grade (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.547), lymph node metastasis (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.074), neoadjuvant therapy (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.139), and adjuvant therapy (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.383); the T stage in the laparoscopic surgery (LAP) group was significantly lower than that in the open surgery (OPEN) group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.041). There were no significant differences after matching. The clinicopathologic characteristics of the two groups before and after matching are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eSurgical Outcomes\u003c/h2\u003e \u003cp\u003eThe operation time and postoperative hospital stay were comparable between the LAP and OPEN groups (176.63\u0026thinsp;\u0026plusmn;\u0026thinsp;56.56 min vs. 172.08\u0026thinsp;\u0026plusmn;\u0026thinsp;86.52 min, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.676; 10.41\u0026thinsp;\u0026plusmn;\u0026thinsp;5.56 days vs. 12.32\u0026thinsp;\u0026plusmn;\u0026thinsp;7.78 days, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.062). Before PSM, R0 resection rate was greater in the LAP group than in the OPEN group (99.1% vs. 95.2%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.049). Moreover, the LAP group had a lower incidence of postoperative complications compared to the OPEN group (13.4% vs. 35.5%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001). After PSM, there was no significant difference in the R0 resection rate between the two groups (98.4% vs. 95.2%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.133). However, the LAP group still had a lower postoperative complication rate compared to the OPEN group (14.5% vs. 35.5%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007). The surgical outcomes of the two groups before and after matching are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eOncologic Outcomes\u003c/h3\u003e\n\u003cp\u003eThe study had a median follow-up period of 34 (range: 1-123) months. The 1-year, 3-year, and 5-year RFS for RNETs patients who underwent radical surgery were 90.3%, 78.1%, and 76.0%, respectively (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The optimal cutoff value for tumor size to predict RFS was determined to be 4.0 cm for two subgroups and 2.0 cm and 4.0 cm for three subgroups. Multivariable analysis revealed that tumor grade (G2: HR: 3.021, 95% CI: 1.145\u0026ndash;7.970, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026) and surgery type (OPEN: HR: 2.043, 95% CI: 1.037\u0026ndash;4.025, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.039) were independent risk factors for RFS. Furthermore, in univariate analysis, patients who underwent adjuvant therapy had a significantly lower RFS compared to those who did not undergo adjuvant therapy (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001). However, we believe that this difference was caused by patient selection bias, and thus this factor was not included in the multivariate analysis. Log-rank test and Cox proportional hazard regression analysis of RFS are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate relapse-free survival analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eClinicopathological factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eMultivariable analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (Male/Female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.538\u0026ndash;2.178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.825\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (\u0026gt;\u0026thinsp;65/\u0026le;65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.635\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.315\u0026ndash;1.279\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.638\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.298\u0026ndash;1.370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.792\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.297\u0026ndash;2.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.642\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor size, cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026thinsp;~\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.853\u0026ndash;3.912\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.658\u0026ndash;6.192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor grade (G2/G1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.200-7.532\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.019\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.145\u0026ndash;7.970\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.026\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery (OPEN\u003csup\u003ea\u003c/sup\u003e /LAP\u003csup\u003eb\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.015\u0026ndash;4.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.045\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.037\u0026ndash;4.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.039\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdjuvant (Yes /No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.602\u0026ndash;6.943\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003ea\u003c/sup\u003eOPEN = open surgery. \u003csup\u003eb\u003c/sup\u003eLAP = laparoscopic surgery. \u003csup\u003ec\u003c/sup\u003eHR = hazard ratio. \u003csup\u003ed\u003c/sup\u003eCI = confidence interval.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBefore PSM, the 1-year, 3-year, and 5-year RFS were 93.6%, 83.2%, and 81.4% in the LAP group and 84.3%, 69.8%, and 67.4% in the OPEN group, the difference was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.045). After PSM, the 1-year, 3-year, and 5-year RFS were 95.2%, 85.3%, and 85.3% in the LAP group and 84.3%, 69.8%, and 67.4% in the OPEN group, the difference was also statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.048). The survival curves according to surgical type before and after PSM were shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA-\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSubgroup Analysis\u003c/h2\u003e \u003cp\u003eTumor size has a great correlation with surgical resection difficulty; thus, we carried out a subgroup analysis based on this factor. In the aforementioned prognostic analysis, we found that the optimal cutoff value of tumor size for predicting RFS was 4.0 cm. In the RNETs\u0026thinsp;\u0026le;\u0026thinsp;4 cm subgroup, there were 49 patients in the LAP group and 55 patients in the OPEN group, while in the RNETs\u0026thinsp;\u0026gt;\u0026thinsp;4 cm subgroup, there were 13 patients in the LAP group and 7 patients in the OPEN group. No significant differences were observed in terms of baseline characteristics.\u003c/p\u003e \u003cp\u003eThere were no significant differences in the R0 resection rate or operation time in either the RNETs\u0026thinsp;\u0026le;\u0026thinsp;4 cm subgroup (100.0% vs. 95.9%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.220; 175.29\u0026thinsp;\u0026plusmn;\u0026thinsp;63.16 min vs. 170.63\u0026thinsp;\u0026plusmn;\u0026thinsp;92.01 min, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.762) or the RNETs\u0026thinsp;\u0026gt;\u0026thinsp;4 cm subgroup (85.7% vs. 92.3%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.299; 167.86\u0026thinsp;\u0026plusmn;\u0026thinsp;40.50 min vs. 177.54\u0026thinsp;\u0026plusmn;\u0026thinsp;64.41 min, P\u0026thinsp;=\u0026thinsp;0.724). The LAP group had a lower incidence of postoperative complications than the OPEN group in the RNETs\u0026thinsp;\u0026le;\u0026thinsp;4 cm subgroup (10.9% vs. 34.7%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004), while no significant difference was observed in the RNETs\u0026thinsp;\u0026gt;\u0026thinsp;4 cm subgroup (42.9% vs. 38.5%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.000). Similarly, the postoperative hospital stay in the LAP group was significantly shorter than that in the OPEN group in the RNETs\u0026thinsp;\u0026le;\u0026thinsp;4 cm subgroup (9.56\u0026thinsp;\u0026plusmn;\u0026thinsp;5.21 days vs. 12.31\u0026thinsp;\u0026plusmn;\u0026thinsp;8.61 days, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.049), while no significant difference was observed in the RNETs\u0026thinsp;\u0026gt;\u0026thinsp;4 cm subgroup (14.43\u0026thinsp;\u0026plusmn;\u0026thinsp;6.60 days vs. 12.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.33 days, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.465). The clinicopathologic characteristics and surgical outcomes of the subgroups are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of demographic and clinicopathological characteristics in subgroup analysis of tumor size after propensity score matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eClinicopathological\u003c/p\u003e \u003cp\u003echaracteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;4cm\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c8\" namest=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;4cm\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLAP\u003csup\u003eb\u003c/sup\u003e group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOPEN\u003csup\u003ec\u003c/sup\u003e group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;49)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLAP group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOPEN group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBaseline characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.849\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (30.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (32.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (46.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (69.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (67.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (53.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, n (%), year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.557\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (61.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (67.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (53.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (38.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (32.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (46.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor site, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.952\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.386\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (63.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (65.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (69.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (29.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (26.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (7.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (8.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor grade, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.357\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (49.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (51.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (85.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 (92.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT stage, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.784\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1\u0026thinsp;+\u0026thinsp;T2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (61.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (59.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT3\u0026thinsp;+\u0026thinsp;T4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (38.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (40.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (85.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 (92.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymph node metastasis, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.585\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (43.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (49.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (56.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (51.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 (92.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdjuvant, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.668\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (67.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (63.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (53.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (32.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (36.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (46.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgical outcomes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResection margin, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (95.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (85.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 (92.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation time, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003csup\u003ea\u003c/sup\u003e, min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e175.29\u0026thinsp;\u0026plusmn;\u0026thinsp;63.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e170.63\u0026thinsp;\u0026plusmn;\u0026thinsp;92.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.762\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e167.86\u0026thinsp;\u0026plusmn;\u0026thinsp;40.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e177.54\u0026thinsp;\u0026plusmn;\u0026thinsp;64.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplication, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (89.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (65.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (61.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (10.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (34.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (38.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative hospital stay, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.56\u0026thinsp;\u0026plusmn;\u0026thinsp;5.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.31\u0026thinsp;\u0026plusmn;\u0026thinsp;8.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.049\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.43\u0026thinsp;\u0026plusmn;\u0026thinsp;6.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003ea\u003c/sup\u003eSD = standard deviation. \u003csup\u003eb\u003c/sup\u003eLAP = laparoscopic surgery. \u003csup\u003ec\u003c/sup\u003eOPEN = open surgery.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe RFS of the LAP group was superior than that of the OPEN group in the RNETs\u0026thinsp;\u0026le;\u0026thinsp;4 cm subgroup (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.025), while no significant difference was found in the RNETs\u0026thinsp;\u0026gt;\u0026thinsp;4 cm subgroup (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.724). The survival curves according to surgical type are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC-\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eD.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eRadical resection, which includes low anterior resection and abdominoperineal resection, is the primary treatment for localized RNETs. However, while radical resection achieves a more complete tumor dissection and improves patient survival, it may also result in poor functional outcomes compared to local excision\u003csup\u003e[12\u0026ndash;16]\u003c/sup\u003e. Therefore, the choice between local excision and radical resection is crucial in managing patients with RNETs. In this study, preoperative imaging results serve as important references for selecting surgical methods for RNETs patients. By effectively communicating with patients and their families, we determined the optimal surgical approach after carefully assessing tumor size, tumor grade, T stage, and lymph node metastasis status. For RNETs, we recommended radical resection for patients with tumor size\u0026thinsp;\u0026gt;\u0026thinsp;2 cm, T stage\u0026thinsp;\u0026gt;\u0026thinsp;T1, lymph node metastasis, or muscularis invasion. For patients with RNEC and RMANEC, radical resection was suggested. These indications for radical resection are similar to those outlined in the CSCO guidelines for RNENs\u003csup\u003e[5]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eLaparoscopic surgery has become the standard treatment recommendation for digestive tract tumor surgery. Several retrospective case-control studies and randomized controlled trials have demonstrated that laparoscopic surgery has a long-term prognosis not inferior to that of open surgery, and has the advantages of less trauma and rapid postoperative recovery\u003csup\u003e[17\u0026ndash;20]\u003c/sup\u003e. However, evidence comparing laparoscopic surgery and open surgery for RNETs has scarcely been described due to their rarity and the even rarer indications for radical surgery. Therefore, we designed and implemented the multicenter study to compare postoperative and oncological outcomes between laparoscopic surgery and open surgery for RNETs. To the best of our knowledge, this is currently the largest study of RNETs in patients who underwent radical resection.\u003c/p\u003e \u003cp\u003eRNETs are located in the pelvic cavity, with complex adjacent organs and narrow surgical space, making precise localization and safe resection difficult. Laparoscopic surgery can effectively reduce traction injury to the surrounding organs by directly reaching the lesion site with extended surgical instruments; Meanwhile, image reproduction is achieved through the endoscope and monitor, which makes it possible for surgeons to observe the surgical field more intuitively, assisting in safe tumor resection. Studies have shown that laparoscopic surgery for NENs in the stomach and small bowel yields short-term outcomes comparable to those of open surgery\u003csup\u003e[21, 22]\u003c/sup\u003e. In this study, we found that laparoscopic surgery for RNETs resulted in a lower incidence of complications and a higher rate of R0 resection compared to open surgery. To improve the credibility of our retrospective data analysis, we performed PSM between the groups to balance the covariates and confounders. After PSM, we still found a lower incidence of postoperative complications in the LAP group, with no significant differences in the R0 resection rate, operation time, or postoperative hospital stay. These results demonstrate that laparoscopic surgery may offer better surgical outcomes for RNETs due to its minimally invasive nature.\u003c/p\u003e \u003cp\u003eAlthough laparoscopic surgery lacks tactile sensation, which poses a risk of tumor rupture and iatrogenic dissemination, studies have shown satisfactory long-term prognosis in laparoscopic resection of RNETs, with a 3-year overall survival rate of 97.8%\u003csup\u003e[8, 9]\u003c/sup\u003e. However, comparisons of laparoscopic and open surgery in terms of oncological outcomes for RNETs are still lacking. In our study, we used the PSM method to minimize the influence of confounding factors. The results suggested that laparoscopic surgery was associated with better RFS than open surgery group before and after PSM. Taken together, we conclude that laparoscopic surgery can serve as a safe and feasible option for radical surgery of RNETs.\u003c/p\u003e \u003cp\u003eTumor size is associated with surgical resection difficulty during the treatment of digestive tract tumors, and a larger tumor size often indicates more complicated surgical procedures, which increases the risk of intraoperative complications. To assess the impact of tumor size on short-term and long-term outcomes, we performed a subgroup analysis of patients with RNETs after PSM using a cutoff of 4 cm. Among patients with RNETs\u0026thinsp;\u0026le;\u0026thinsp;4 cm, those in the laparoscopic group had fewer complications, shorter postoperative hospital stays, and superior RFS compared with those in the open group, whereas among patients with RNETs\u0026thinsp;\u0026gt;\u0026thinsp;4 cm, the short-term and long-term outcomes did not significantly differ between the laparoscopic group and the open group. Similarly, previous studies at our medical center have shown that in rectal gastrointestinal stromal tumors, laparoscopic surgery is associated with superior RFS and fewer complications only in patients\u0026thinsp;\u0026le;\u0026thinsp;5 cm, whereas these advantages were lost in patients in the \u0026gt;\u0026thinsp;5 cm group\u003csup\u003e[23]\u003c/sup\u003e. These results may suggest that laparoscopic surgery has advantages related to tumor size in the management of rectal neoplasms.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, although we used PSM to reduce potential bias and performed subgroup analysis to investigate the impact of surgical approach on patient outcomes, the retrospective nature of the study still affects its statistical power and clinical value. In addition, RNETs are slow-growing tumors\u003csup\u003e[24]\u003c/sup\u003e, and a longer follow-up period is required for a comprehensive clinical evaluation of patient status. However, to the best of our knowledge, this is currently the largest study comparing laparoscopic surgery with open surgery for RNETs and can provide valuable guidance for their treatment.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn summary, laparoscopic surgery is a safe and feasible option for the radical resection of localized RNETs. For patients with RNETs\u0026thinsp;\u0026le;\u0026thinsp;4 cm, laparoscopic surgery was associated with a superior RFS, a reduced rate of complications, and shorter postoperative hospital stays, whereas the R0 resection rate and operation time were comparable to those of open surgery. For patients with RNETs\u0026thinsp;\u0026gt;\u0026thinsp;4 cm, laparoscopic surgery has oncologic and surgical outcomes similar to those of open surgery.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAJCC: American Joint Committee on Cancer\u003c/p\u003e\n\u003cp\u003eCSCO: Chinese Society of Clinical Oncology\u003c/p\u003e\n\u003cp\u003eENETS: European Neuroendocrine Tumor Society\u003c/p\u003e\n\u003cp\u003eNCCN: National Comprehensive Cancer Network\u003c/p\u003e\n\u003cp\u003eNENs: Neuroendocrine neoplasms\u003c/p\u003e\n\u003cp\u003ePSM: Propensity score matching\u003c/p\u003e\n\u003cp\u003eRFS: Relapse-free survival\u003c/p\u003e\n\u003cp\u003eRMANEC: Rectal mixed adenoneuroendocrine carcinoma\u003c/p\u003e\n\u003cp\u003eRNEC: Rectal neuroendocrine carcinoma\u003c/p\u003e\n\u003cp\u003eRNENs: Rectal neuroendocrine neoplasms\u003c/p\u003e\n\u003cp\u003eRNETs: Rectal neuroendocrine tumors\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWeizhong Jiang and Kaixiong Tao had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.\u003c/p\u003e\n\u003cp\u003eConcept and design: Chengguo Li, Weizhong Jiang, Kaixiong Tao.\u003c/p\u003e\n\u003cp\u003eAcquisition, analysis, or interpretation of data: Xinyu Zeng, Chengguo Li, Minhao Yu, Rui Zhang, Guole Lin, Maojun Di, Hongxue Wu, Yueming Sun, Zhiguo Xiong, Congqing Jiang, Bin Yu, Shengning Zhou, Yong Li, Xiaofeng Liao, Lijian Xia, Wei Zhang.\u003c/p\u003e\n\u003cp\u003eDrafting of the manuscript: Xinyu Zeng, Chengguo Li.\u003c/p\u003e\n\u003cp\u003eCritical revision of the manuscript for important intellectual content: Minhao Yu, Rui Zhang, Guole Lin, Maojun Di, Hongxue Wu, Yueming Sun, Zhiguo Xiong, Congqing Jiang, Bin Yu, Shengning Zhou, Yong Li, Xiaofeng Liao, Lijian Xia, Wei Zhang, Weizhong Jiang, Kaixiong Tao.\u003c/p\u003e\n\u003cp\u003eStatistical analysis: Minhao Yu, Rui Zhang, Guole Lin, Maojun Di, Hongxue Wu, Yueming Sun.\u003c/p\u003e\n\u003cp\u003eAdministrative, technical, or material support: Zhiguo Xiong, Congqing Jiang, Bin Yu, Shengning Zhou, Yong Li, Xiaofeng Liao, Lijian Xia, Wei Zhang, Weizhong Jiang, Kaixiong Tao.\u003c/p\u003e\n\u003cp\u003eSupervision: Weizhong Jiang, Kaixiong Tao.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis study was funded by the National Natural Science Foundation of China (Grant No. 81702386 and 81874184), and the Key Project of Hubei Health Commission (Grant No.WJ2019Q030).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThis study conforms to the Declaration of Helsinki. Our work was approved by the Ethics Committee of all 17 participating centers. At the last follow-up, we informed the alive patients about the study in detail and obtained the informed consent signed by them. For patients who were not alive at the time of the study, we contacted their immediate family members, explained the study in detail and obtained the informed consent forms signed by them.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDasari A, Shen C, Halperin D, et al. Trends in the Incidence, Prevalence, and Survival Outcomes in Patients With Neuroendocrine Tumors in the United States. JAMA Oncol. 2017;3(10):1335-1342. \u0026lt;DOI: 10.1001/jamaoncol.2017.0589\u0026gt; \u0026lt;PMID: 28448665\u0026gt;\u003c/li\u003e\n\u003cli\u003eCives M, Strosberg JR. Gastroenteropancreatic Neuroendocrine Tumors. 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Endocr J. 2023;70(2):197-205. \u0026lt;DOI: 10.1507/endocrj.EJ22-0262\u0026gt; \u0026lt;PMID: 36403965\u0026gt;\u003c/li\u003e\n\u003cli\u003eGallo C, Rossi RE, Cavalcoli F, et al. Rectal neuroendocrine tumors: Current advances in management, treatment, and surveillance. World J Gastroenterol. 2022;28(11):1123-1138. \u0026lt;DOI: 10.3748/wjg.v28.i11.1123\u0026gt; \u0026lt;PMID: 35431507\u0026gt;\u003c/li\u003e\n\u003cli\u003eSekiguchi M, Matsuda T, Saito Y. Treatment strategy and post-treatment management of colorectal neuroendocrine tumor. DEN Open. 2023;4(1):e254. \u0026lt;DOI: 10.1002/deo2.254\u0026gt; \u0026lt;PMID: 37313123\u0026gt;\u003c/li\u003e\n\u003cli\u003eZhao YJ, Zhuang LP, Liu YY, et al. Comparative study of laparoscopic versus open radical gastrectomy in advanced gastric neuroendocrine carcinoma: Analysis from a high-volume institution. 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Gut Liver. 2022;16(2):228-235. \u0026lt;DOI: 10.5009/gnl20364\u0026gt; \u0026lt;PMID: 34552040\u0026gt;\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Neuroendocrine tumors, Laparoscopic surgery, Open surgery, Prognosis, Rectum","lastPublishedDoi":"10.21203/rs.3.rs-4509547/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4509547/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDue to the lack of large sample evidence-based medical studies, the surgical approach for radical resection of rectal neuroendocrine tumors is controversial.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWe 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%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.048) and superior relapse-free survival (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;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%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004), shorter postoperative hospital stays (9.56\u0026thinsp;\u0026plusmn;\u0026thinsp;5.21 days vs 12.31\u0026thinsp;\u0026plusmn;\u0026thinsp;8.61 days, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.049) and superior relapse-free survival (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.025) in the rectal neuroendocrine tumors\u0026thinsp;\u0026le;\u0026thinsp;4 cm subgroup.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eLaparoscopic surgery is associated with improved postoperative outcomes and oncologic prognosis for patients with rectal neuroendocrine tumors\u0026thinsp;\u0026le;\u0026thinsp;4 cm and can serve as a safe and feasible option of radical surgery of rectal neuroendocrine tumors.\u003c/p\u003e","manuscriptTitle":"Laparoscopic Versus Open Surgery for Rectal Neuroendocrine Tumors: A Multicenter Real-World Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-18 21:56:20","doi":"10.21203/rs.3.rs-4509547/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-04T15:02:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-04T14:29:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-03T08:05:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cancer","date":"2024-05-31T14:14:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"18c78bd0-46b6-4b2d-91d4-9ad7468e8ccf","owner":[],"postedDate":"June 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-08-12T16:04:00+00:00","versionOfRecord":{"articleIdentity":"rs-4509547","link":"https://doi.org/10.1186/s12885-024-12711-x","journal":{"identity":"bmc-cancer","isVorOnly":false,"title":"BMC Cancer"},"publishedOn":"2024-08-05 15:57:43","publishedOnDateReadable":"August 5th, 2024"},"versionCreatedAt":"2024-06-18 21:56:20","video":"","vorDoi":"10.1186/s12885-024-12711-x","vorDoiUrl":"https://doi.org/10.1186/s12885-024-12711-x","workflowStages":[]},"version":"v1","identity":"rs-4509547","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4509547","identity":"rs-4509547","version":["v1"]},"buildId":"cTy_lsJlmDsVRNrSptgXS","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}