Surveillance of Small Rectal Carcinoid Tumors in the Absence of Metastatic Disease
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The incidence of rectal carcinoids is rapidly increasing, typically presenting as small (<1.0 cm), localized tumors. Although the evaluation of rectal carcinoids on presentation is well standardized, surveillance after resection has not been well established.
A prospective database documented patients with rectal carcinoids at our institution between January 1995 and September 2011. Information collected included patient and tumor characteristics, treatment method, surveillance schedule, recurrence, and survival.
Twenty-eight patients with rectal carcinoid were identified. Ten patients were excluded for tumors >1 cm, known metastases at presentation, <6 months follow-up, or previous resections. The mean age of the remaining patients was 56 ± 3 years, and 61 % of the patients were female. All patients were diagnosed at endoscopy, with 50 % diagnosed incidentally on screening endoscopy. Treatment methods included endoscopic therapy (n = 13, 72 %), transanal excision (n = 3, 17 %), and transanal endoscopic microsurgery (n = 1, 5.5 %). One patient (5.5 %) received no additional invasive therapy after diagnostic endoscopy. The mean tumor diameter was 4.6 ± 0.5 mm. The average length of follow-up was 5.4 ± 0.9 years, with a median number of 2 follow-up endoscopies (range 0–6). Two patients (11 %) died within the follow-up period from noncarcinoid causes. Importantly, no surviving patients developed local or distant recurrence with up to 12.3 years of follow-up.
On the basis of this experience, patients presenting with small (≤1.0 cm), nonmetastatic rectal carcinoids are unlikely to develop local or distant recurrence after resection. Aggressive surveillance with repeat endoscopies or other imaging studies after resection may be unnecessary in this patient population.
- Kulchitsky N. Zur Frage über den Bau des Darmkanals. Arch F Mikroskop Anat Bd. 1897;49.
- Erspamer, V, Asero, B (1952) Identification of enteramine, the specific hormone of the enterochromaffin cell system, as 5-hydroxytryptamine. Nature. 169: pp. 800-801 CrossRef
- Ellis, L, Shale, MJ, Coleman, MP (2010) Carcinoid tumors of the gastrointestinal tract: trends in incidence in England since 1971. Am J Gastroenterol. 105: pp. 2563-2569 CrossRef
- Modlin, IM, Sandor, A (1997) An analysis of 8305 cases of carcinoid tumors. Cancer. 79: pp. 813-829 CrossRef
- Modlin, IM, Lye, KD, Kidd, M (2003) A 5-decade analysis of 13,715 carcinoid tumors. Cancer. 97: pp. 934-959 CrossRef
- Moore, JR, Greenwell, B, Nuckolls, K (2011) Neuroendocrine tumors of the rectum: a 10-year review of management. Am Surg. 77: pp. 198-200
- Pinchot, SN, Holen, K, Sippel, RS (2008) Carcinoid tumors. Oncologist. 13: pp. 1255-1269 CrossRef
- Jetmore, AB, Ray, JE, Gathright, JB (1992) Rectal carcinoids: the most frequent carcinoid tumor. Dis Colon Rectum. 35: pp. 717-725 CrossRef
- Soga, J (1997) Carcinoids of the rectum: an evaluation of 1271 reported cases. Surg Today. 27: pp. 112-119 CrossRef
- Li, AF, Hsu, CY, Li, A (2008) A 35-year retrospective study of carcinoid tumors in Taiwan: differences in distribution with a high probability of associated second primary malignancies. Cancer. 112: pp. 274-283 CrossRef
- Sauven, P, Ridge, JA, Quan, SH (1990) Anorectal carcinoid tumors. Is aggressive surgery warranted?. Ann Surg. 211: pp. 67-71 CrossRef
- Kwaan, MR, Goldberg, JE, Bleday, R (2008) Rectal carcinoid tumors: review of results after endoscopic and surgical therapy. Arch Surg. 143: pp. 471-475 CrossRef
- Tsai, BM, Finne, CO, Nordenstam, JF (2010) Transanal endoscopic microsurgery resection of rectal tumors: outcomes and recommendations. Dis Colon Rectum. 53: pp. 16-23 CrossRef
- Onozato, Y, Kakizaki, S, Iizuka, H (2010) Endoscopic treatment of rectal carcinoid tumors. Dis Colon Rectum. 53: pp. 169-176 CrossRef
- Yoon, SN, Yu, CS, Shin, US (2010) Clinicopathologic characteristics of rectal carcinoids. Int J Colorectal Dis. 25: pp. 1087-1092 CrossRef
- Shields, CJ, Tiret, E, Winter, DC (2010) Carcinoid tumors of the rectum: a multi-institutional international collaboration. Ann Surg. 252: pp. 750-755 CrossRef
- Edge, SB, Byrd, DR, Compton, CC (2010) AJCC cancer staging manual. Springer, New York
- Ramage, JK, Goretzki, PE, Manfredi, R (2008) Consensus guidelines for the management of patients with digestive neuroendocrine tumours: well-differentiated colon and rectum tumour/carcinoma. Neuroendocrinology. 87: pp. 31-39 CrossRef
- Koura, AN, Giacco, GG, Curley, SA (1997) Carcinoid tumors of the rectum: effect of size, histopathology, and surgical treatment on metastasis free survival. Cancer. 79: pp. 1294-1298 CrossRef
- Sippel, RS, Chen, H (2006) Carcinoid tumors. Surg Oncol Clin N Am. 15: pp. 463-478 CrossRef
- Surveillance of Small Rectal Carcinoid Tumors in the Absence of Metastatic Disease
Annals of Surgical Oncology
Volume 19, Issue 11 , pp 3486-3490
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
- 2. Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI, USA