Abstract
Background
Various endoscopic techniques for rectal carcinoid tumors have been developed recently. In this study, we compared the outcomes of conventional endoscopic mucosal resection (EMR), strip biopsy, and EMR after circumferential precutting (EMR-P).
Methods
From March 2004 to July 2014, the medical records of 188 patients (190 rectal carcinoid tumors) who were treated with an endoscopic procedure for rectal carcinoid tumors were investigated retrospectively. The characteristics of the patients and tumors, the selection of the treatment method, the rate of complete resection, and the rate of complications were analyzed retrospectively.
Results
Forty-seven, 75 and 68 cases of EMR, strip biopsy and EMR-P were performed, respectively. The mean procedure time was not significantly different between the EMR, strip biopsy and EMR-P cases (5.6, 6.5 and 7.4 min, respectively, P = 0.119). En bloc resection was achieved in most of the cases (97.8, 98.7 and 95.5 % in the EMR, strip biopsy and EMR-P cases, respectively). However, histologic examination showed positive lateral or deep resection margins in 57 out of 190 cases (30.0 %). Multivariate analysis showed that the strip biopsy and EMR-P methods were independent factors for pathologic complete resection (negative in both lateral and deep resection margins), with odds ratios for margin involvement of 0.20 and 0.43 with 95 % confidence intervals from 0.08 to 0.47 and 0.19 to 0.96, respectively. In all the follow-up cases (81 of 190, 42.6 %), no local recurrence or distal metastasis was found.
Conclusions
Compared to conventional EMR, strip biopsy and EMR-P had a lower risk of incomplete resection. The procedure time and complication rate did not differ between the three groups, and no recurrence was detected during the follow-up period. Strip biopsy and EMR-P are safe and effective methods for the treatment of rectal carcinoid tumors.
Similar content being viewed by others
References
Modlin IM, Sandor A (1997) An analysis of 8305 cases of carcinoid tumors. Cancer 79(4):813–829
Scherubl H, Kloppel G (2009) Rectal carcinoids on the rise-update. Z Gastroenterol 47(4):365–371
Shields CJ, Tiret E, Winter DC, International Rectal Carcinoid Study G (2010) Carcinoid tumors of the rectum: a multi-institutional international collaboration. Ann Surg 252(5):750–755
Al Natour RH, Saund MS, Sanchez VM, Whang EE, Sharma AM, Huang Q, Boosalis VA, Gold JS (2012) Tumor size and depth predict rate of lymph node metastasis in colon carcinoids and can be used to select patients for endoscopic resection. J Gastrointest Surg 16(3):595–602
Fujimoto Y, Oya M, Kuroyanagi H, Ueno M, Akiyoshi T, Yamaguchi T, Muto T (2010) Lymph-node metastases in rectal carcinoids. Langenbecks Arch Surg 395(2):139–142
Lin HH, Lin JK, Jiang JK, Lin CC, Lan YT, Yang SH, Wang HS, Chen WS, Lin TC, Liang WY, Chang SC (2014) Clinicopathological analysis of colorectal carcinoid tumors and patient outcomes. World J Surg Oncol 12:366
Kwaan MR, Goldberg JE, Bleday R (2008) Rectal carcinoid tumors: review of results after endoscopic and surgical therapy. Arch Surg 143(5):471–475
Choi HH, Kim JS, Cheung DY, Cho YS (2013) Which endoscopic treatment is the best for small rectal carcinoid tumors? World J Gastrointest Endosc 5(10):487–494
Saito Y, Otake Y, Sakamoto T, Nakajima T, Yamada M, Haruyama S, So E, Abe S, Matsuda T (2013) Indications for and technical aspects of colorectal endoscopic submucosal dissection. Gut Liver 7(3):263–269
Hamada Y, Tanaka K, Tano S, Katsurahara M, Kosaka R, Noda T, Aoki M, Toyoda H, Takei Y, Katayama N (2012) Usefulness of endoscopic submucosal dissection for the treatment of rectal carcinoid tumors. Eur J Gastroenterol Hepatol 24(7):770–774
Zhong DD, Shao LM, Cai JT (2013) Endoscopic mucosal resection vs endoscopic submucosal dissection for rectal carcinoid tumours: a systematic review and meta-analysis. Colorectal Dis 15(3):283–291
Moon SH, Hwang JH, Sohn DK, Park JW, Hong CW, Han KS, Chang HJ, Oh JH (2011) Endoscopic submucosal dissection for rectal neuroendocrine (carcinoid) tumors. J Laparoendos Adv Surg Tech A 21(8):695–699
Park HW, Byeon JS, Park YS, Yang DH, Yoon SM, Kim KJ, Ye BD, Myung SJ, Yang SK, Kim JH (2010) Endoscopic submucosal dissection for treatment of rectal carcinoid tumors. Gastrointest Endosc 72(1):143–149
Zhou PH, Yao LQ, Qin XY, Xu MD, Zhong YS, Chen WF, Ma LL, Zhang YQ, Qin WZ, Cai MY, Ji Y (2010) Advantages of endoscopic submucosal dissection with needle-knife over endoscopic mucosal resection for small rectal carcinoid tumors: a retrospective study. Surg Endosc 24(10):2607–2612
Zhou PH, Yao LQ, Xu MD, Chen WF, Zhong YS, Gao WD, He GJ, Qin XY (2007) Endoscopic submucosal dissection for rectal carcinoid tumors. Zhonghua Wei Chang Wai Ke Za Zhi 10(4):319–322
Onozato Y, Kakizaki S, Ishihara H, Iizuka H, Sohara N, Okamura S, Mori M, Itoh H (2007) Endoscopic submucosal dissection for rectal tumors. Endoscopy 39(5):423–427
Onozato Y, Kakizaki S, Iizuka H, Sohara N, Mori M, Itoh H (2010) Endoscopic treatment of rectal carcinoid tumors. Dis Colon Rectum 53(2):169–176
Kim YJ, Lee SK, Cheon JH, Kim TI, Lee YC, Kim WH, Chung JB, Yi SW, Park S (2008) Efficacy of endoscopic resection for small rectal carcinoid: a retrospective study. Korean J Gastroenterol 51(3):174–180
Choi CW, Kang DH, Kim HW, Park SB, Jo WS, Song GA, Cho M (2013) Comparison of endoscopic resection therapies for rectal carcinoid tumor: endoscopic submucosal dissection versus endoscopic mucosal resection using band ligation. J Clin Gastroenterol 47(5):432–436
Kim KM, Eo SJ, Shim SG, Choi JH, Min BH, Lee JH, Chang DK, Kim YH, Rhee PL, Kim JJ, Rhee JC, Kim JY (2013) Treatment outcomes according to endoscopic treatment modalities for rectal carcinoid tumors. Clin Res Hepatol Gastroenterol 37(3):275–282
He L, Deng T, Luo H (2015) Efficacy and safety of endoscopic resection therapies for rectal carcinoid tumors: a meta-analysis. Yonsei Med J 56(1):72–81
Niimi K, Goto O, Fujishiro M, Kodashima S, Ono S, Mochizuki S, Asada-Hirayama I, Konno-Shimizu M, Mikami-Matsuda R, Minatsuki C, Yamamichi N, Koike K (2012) Endoscopic mucosal resection with a ligation device or endoscopic submucosal dissection for rectal carcinoid tumors: an analysis of 24 consecutive cases. Dig Endosc 24(6):443–447
Zhao ZF, Zhang N, Ma SR, Yang Z, Han X, Zhao YF, Gao F, Gong ZJ, Yang L (2012) A comparative study on endoscopy treatment in rectal carcinoid tumors. Surg Laparosc Endosc Percutan Tech 22(3):260–263
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Hyun Joo Lee, Seong Beom Kim, Cheol Min Shin, A. Young Seo, Dong Ho Lee, Nayoung Kim, Young Soo Park and Hyuk Yoon have no conflicts of interest or financial ties to disclose.
Additional information
Hyun Joo Lee and Seong Beom Kim have equally contributed to this work.
Rights and permissions
About this article
Cite this article
Lee, H.J., Kim, S.B., Shin, C.M. et al. A comparison of endoscopic treatments in rectal carcinoid tumors. Surg Endosc 30, 3491–3498 (2016). https://doi.org/10.1007/s00464-015-4637-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-015-4637-4