This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on HighWire  • Citing articles on Web of Science (2)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in this journal  Topic Collections  • Surgery  • Surgical Interventions  • Colorectal Surgery  • Endoscopy/ Minimally Invasive Surgery  • Surgical Oncology  • Prognosis/ Outcomes  • Alert me on articles by topic  Social Bookmarking   What's this?

Review of Results After Endoscopic and Surgical Therapy

Mary R. Kwaan, MD, MPH; Joel E. Goldberg, MD; Ronald Bleday, MD

Arch Surg. 2008;143(5):471-475.

Objective  To assess whether endoscopic treatment can clear local disease in patients with carcinoid tumor.

Design  Retrospective cohort study.

Setting  Tertiary care academic medical center.

Patients  All patients diagnosed as having a neuroendocrine tumor or carcinoid tumor of the rectum who were evaluated at our institution between January 1, 1990, and December 31, 2006.

Main Outcome Measure  Margin status of tumor resection.

Results  Eighty-five patients were identified (median age at diagnosis, 55 years). Thirty-three tumors (39%) were asymptomatic and diagnosed during screening colonoscopy. Eleven tumors (13%) were metastatic at presentation. Of the 85 tumors, 48 (56%) were smaller than 1.0 cm. Endoscopic therapy was performed in 46 patients (54%). Of these, 38 patients (83%) had tumors with positive or indeterminate margins on histologic examination; of whom 6 (16%) had residual tumor on subsequent endoscopy and 1 (3%) had recurrence as metastatic disease. One patient who had a negative margin had residual tumor on follow-up. Thirty-one patients (36%) underwent surgical resection; of these, 23 (74%) underwent transanal excision or transanal endoscopic microsurgery, 6 (19%) underwent low anterior resection, and 2 (6%) underwent abdominoperineal resection. Eight patients who did not receive local clearance of tumor had metastases on presentation, had another active malignant neoplasm, or refused further surgical treatment. Among the 85 patients, 4 metastases occurred during follow-up, including 2 from tumors smaller than 1.0 cm at presentation.

Conclusions  Endoscopic treatment is sufficient for tumors that are small, for tumors limited to the mucosa, and when a margin is negative for tumor. Transanal excision should be considered when margins of endoscopic resection are positive. We recommend rectal resection for tumors that are 1.0 to 1.9 cm and have high-risk features.

Author Affiliations: Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTER

Local Therapy of Rectal Carcinoids: A Matter of Debate
Hans Scherübl
Arch Surg. 2009;144(2):195-196.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Local Therapy of Rectal Carcinoids: A Matter of Debate
Scherubl
Arch Surg 2009;144:195-196.
FULL TEXT