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Surgical Endoscopy

, Volume 28, Issue 7, pp 2020–2026 | Cite as

Rectal carcinoids: a systematic review

  • Frank D. McDermott
  • Anna Heeney
  • Danielle Courtney
  • Helen Mohan
  • Des Winter
Review

Abstract

Background

Rectal carcinoids are increasing in incidence worldwide. Frequently thought of as a relatively benign condition, there are limited data regarding optimal treatment strategies for both localized and more advanced disease. The aim of this study was to summarize published experiences with rectal carcinoids and to present the most current data.

Methods

Following PRISMA guidelines, an electronic literature search performed of PubMed, Medline, Embase, and the Cochrane Library using the terms “rectum” or “rectal” AND “carcinoid” over a 20-year study period from January 1993 to May 2013. Non-English-language studies, animal studies, and studies of fewer than 100 patients were excluded. Study end points included demographic information, tumor features, intervention and outcomes. All included articles were quality assessed.

Results

Using the search parameters and exclusions as outlined above, a total of 14 articles were identified for detailed analysis. The quality of articles was low/moderate for all included scoring 9 to 17 of 27. The articles included 4,575 patients diagnosed with a rectal carcinoid. Approximately 80 % of tumors were <10 mm, 15 % 11–20 mm, and 5 % >20 mm. Eight percent of patients presented with regional lymph node metastases, and 4 % presented with distant metastases. Tumor size >10 mm, and muscular and lymphovascular invasion are independently associated with an increased risk of metastases. The 5-year survival was 93 % in patients presenting with localized disease and 86 % overall.

Conclusions

Small tumors up to 10 mm without any adverse features can be treated with endoscopic or local excision. The treatment of carcinoids between 10 and 20 mm is still contentious, but those up to 16 mm without adverse feature are suitable for local/endoscopic excision followed by careful histopathological assessment. Those >20 mm or with adverse features require radical surgery with mesorectal clearance in suitable patients.

Keywords

Carcinoid Outcomes Prognostic factors Rectal 

Notes

Disclosures

Mr. McDermott, Miss Heeney, Dr. Courtney, Miss Mohan, and Professor Winter have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Langhans T (1867) Ueber einen drusenpolyp im ileum. Virchows Arch Pathol Anat Physiol Klin Med 38:559–560CrossRefGoogle Scholar
  2. 2.
    Lubarsch O (1888) Uber den primaren Krebs des ileum nebst Bemerkungen uber das gleichzeitige Vorkommen von Krebs and Tuberkulose. Virchows Arch 3:280–317CrossRefGoogle Scholar
  3. 3.
    Oberndorfer S (1907) Karzinoide tumoren des dunndarms. Frankf Z Pathol 1:426–432Google Scholar
  4. 4.
    Anthony LB, Strosberg JR, Klimstra DS et al (2010) The NANETS consensus guidelines for the diagnosis and management of gastrointestinal neuroendocrine tumors (NETS): well-differentiated nets of the distal colon and rectum. Pancreas 39:767–774PubMedCrossRefGoogle Scholar
  5. 5.
    Soga J (1997) Carcinoids of the rectum: an evaluation of 1271 reported cases. Surg Today 27:112–119PubMedCrossRefGoogle Scholar
  6. 6.
    Scherubl H (2009) Rectal carcinoids are on the rise: early detection by screening endoscopy. Endoscopy 41:162–165PubMedCrossRefGoogle Scholar
  7. 7.
    Modlin IM, Lye KD, Kidd M (2003) A 5-decade analysis of 13,715 carcinoid tumors. Cancer 97:934–959PubMedCrossRefGoogle Scholar
  8. 8.
    Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17:1471–1474PubMedCrossRefGoogle Scholar
  9. 9.
    Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Commun Health 52:377–384CrossRefGoogle Scholar
  10. 10.
    Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Maggard MA, O’Connell JB, Ko CY (2004) Updated population-based review of carcinoid tumors. Ann Surg 240:117–122PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Kim MS, Hur H, Min BS et al (2013) Clinical outcomes for rectal carcinoid tumors according to a new (AJCC 7th edition) TNM staging system: a single institutional analysis of 122 patients. J Surg Oncol 107:835–841PubMedCrossRefGoogle Scholar
  13. 13.
    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 15:283–291PubMedCrossRefGoogle Scholar
  14. 14.
    Lee DS, Jeon SW, Park SY et al (2010) The feasibility of endoscopic submucosal dissection for rectal carcinoid tumors: comparison with endoscopic mucosal resection. Endoscopy 42:647–651PubMedCrossRefGoogle Scholar
  15. 15.
    Onozato Y, Kakizaki S, Iizuka H et al (2010) Endoscopic treatment of rectal carcinoid tumors. Dis Colon Rectum 53:169–176PubMedCrossRefGoogle Scholar
  16. 16.
    Park HW, Byeon JS, Park YS et al (2010) Endoscopic submucosal dissection for treatment of rectal carcinoid tumors. Gastrointest Endosc 72:143–149PubMedCrossRefGoogle Scholar
  17. 17.
    Zhou PH, Yao LQ, Qin XY et al (2010) Advantages of endoscopic submucosal dissection with needle-knife over endoscopic mucosal resection for small rectal carcinoid tumors: a retrospective study. Surg Endosc 24:2607–2612PubMedCrossRefGoogle Scholar
  18. 18.
    Son HJ, Sohn DK, Hong CW et al (2013) Factors associated with complete local excision of small rectal carcinoid tumor. Int J Colorectal Dis 28:57–61PubMedCrossRefGoogle Scholar
  19. 19.
    Kim HH, Park SJ, Lee SH et al (2012) Efficacy of endoscopic submucosal resection with a ligation device for removing small rectal carcinoid tumor compared with endoscopic mucosal resection: analysis of 100 cases. Dig Endosc 24:159–163PubMedCrossRefGoogle Scholar
  20. 20.
    Kim KM, Eo SJ, Shim SG et al (2013) Treatment outcomes according to endoscopic treatment modalities for rectal carcinoid tumors. Clin Res Hepatol Gastroenterol. doi: 10.1016/j.clinre.2012.07.007 Google Scholar
  21. 21.
    Kasuga A, Chino A, Uragami N et al (2012) Treatment strategy for rectal carcinoids: a clinicopathological analysis of 229 cases at a single cancer institution. J Gastroenterol Hepat 27:1801–1807CrossRefGoogle Scholar
  22. 22.
    Colonoscopy Study Group of Korean Society of C (2011) Clinical characteristics of colorectal carcinoid tumors. J Korean Soc Coloproctol 27:17–20CrossRefGoogle Scholar
  23. 23.
    Shields CJ, Tiret E, Winter DC et al (2010) Carcinoid tumors of the rectum: a multi-institutional international collaboration. Ann Surg 252:750–755PubMedCrossRefGoogle Scholar
  24. 24.
    Yoon SN, Yu CS, Shin US et al (2010) Clinicopathological characteristics of rectal carcinoids. Int J Colorectal Dis 25:1087–1092PubMedCrossRefGoogle Scholar
  25. 25.
    Wang M, Peng J, Yang W et al (2011) Prognostic analysis for carcinoid tumours of the rectum: a single institutional analysis of 106 patients. Colorectal Dis 13:150–153PubMedCrossRefGoogle Scholar
  26. 26.
    Kim BN, Sohn DK, Hong CW et al (2008) Atypical endoscopic features can be associated with metastasis in rectal carcinoid tumors. Surg Endosc 22:1992–1996PubMedCrossRefGoogle Scholar
  27. 27.
    Li AF, Hsu CY, Li A et al (2008) A 35-year retrospective study of carcinoid tumors in Taiwan: differences in distribution with a high probability of associated second primary malignancies. Cancer 112:274–283PubMedCrossRefGoogle Scholar
  28. 28.
    Soga J (2005) Early-stage carcinoids of the gastrointestinal tract: an analysis of 1914 reported cases. Cancer 103:1587–1595PubMedCrossRefGoogle Scholar
  29. 29.
    Modlin IM, Oberg K, Chung DC et al (2008) Gastroenteropancreatic neuroendocrine tumours. Lancet Oncol 9:61–72PubMedCrossRefGoogle Scholar
  30. 30.
    Kobayashi K, Katsumata T, Yoshizawa S et al (2005) Indications of endoscopic polypectomy for rectal carcinoid tumors and clinical usefulness of endoscopic ultrasonography. Dis Colon Rectum 48:285–291PubMedCrossRefGoogle Scholar
  31. 31.
    Ramage JK, Davies AH, Ardill J et al (2005) UKNETwork for Neuroendocrine Tumours Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours. Gut 54(suppl 4):1–16Google Scholar
  32. 32.
    Rindi G, Arnold R, Bosman FT, Capella C, Klimstra DS, Kloppel G, Komminoth P, Solcia E (2010) Nomenclature and classification of neuroendocrine neoplasms of the digestive system. In: Bosman FT, Carneiro F, Hruban RH, Theise ND (eds) Who classification of tumours of the digestive system, 4th edn. IARC, Lyon, pp 13–14Google Scholar
  33. 33.
    Modlin IM, Kidd M, Latich I et al (2005) Current status of gastrointestinal carcinoids. Gastroenterology 128:1717–1751PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Frank D. McDermott
    • 1
    • 2
  • Anna Heeney
    • 1
    • 2
  • Danielle Courtney
    • 1
    • 2
  • Helen Mohan
    • 1
    • 2
  • Des Winter
    • 1
    • 2
  1. 1.Institute for Clinical Outcomes, Research and Education (ICORE)St Vincent’s University HospitalDublin 4Republic of Ireland
  2. 2.Department of SurgerySt Vincent’s University HospitalDublin 4Republic of Ireland

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