Redefining therapeutic thresholds and global guidelines: Toward precision management of intermediate-sized rectal neuroendocrine tumors

With the widespread adoption of colonoscopic screening, the detection rate of rectal neuroendocrine tumors (rNETs) has risen year by year. Treatment strategies for small (< 1 cm) and large (> 2 cm) lesions are relatively well established, but the optimal management pathway for intermediate-sized (1-2 cm) rNETs remains controversial. Inspired by the recent study by Kim <i>et al</i>, this editorial summarizes differences among international guidelines for managing intermediate-sized rNETs, the selection and latest advances in endoscopic techniques, and examines the feasibility and oncologic safety of endoscopic resection for intermediate-sized rNETs. We contend that future management should focus on the clinical application of molecular stratification, biomarkers, and dynamic risk modeling to enable individualized decision-making. Given global disparities in medical resources, a tiered care system based on risk stratification and resource availability should be established to ensure the safety, equity, and accessibility of rNETs treatment.