Abstract
Background
Although various guidelines regarding neuroendocrine tumors were released, treatment for rectal neuroendocrine tumors with size between 1 and 2 cm has not been explicitly elucidated. The determinant factor of the choice between endoscopic resection and radical surgery is whether lymph node involvement exists.
Aim
This study aims to explore factors associated with lymph node involvement in rectal neuroendocrine tumors by conducting a meta-analysis.
Methods
A broad literature research of Pubmed, Embase&Medline, and The Cochrane Library was performed, and systematic review and meta-analysis about factors associated with lymph node involvement were conducted.
Results
Seven studies were included in this meta-analysis. Tumor size > 1 cm (odds ratio (OR) 6.72, 95 % confidence interval (CI) [3.23, 14.02]), depth of invasion (OR 5.06, 95 % CI [2.30, 11.10]), venous invasion (OR 5.92, 95 % CI [2.21, 15.87]), and central depression (OR 3.00, 95 % CI [1.07, 8.43]) were significantly associated with lymph node involvement.
Conclusion
The available clinical evidence suggests that tumor size > 1 cm, invasion of muscularis properia, venous invasion, and central depression could be risk factors of lymph node involvement, while other factors reported by few studies need further research.
Similar content being viewed by others
References
Shields C J, Tiret E, Winter D C. Carcinoid tumors of the rectum: a multi-institutional international collaboration. Ann Surg, 2010, 252(5):750–755.
Tsikitis V L, Wertheim B C, Guerrero M A. Trends of incidence and survival of gastrointestinal neuroendocrine tumors in the United States: a seer analysis. J Cancer, 2012, 3:292–302.
Ito T, Sasano H, Tanaka M, et al. Epidemiological study of gastroenteropancreatic neuroendocrine tumors in Japan. J Gastroenterol, 2010, 45(2):234–243.
Caplin M, Sundin A, Nillson O, et al. ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms: colorectal neuroendocrine neoplasms. Neuroendocrinology, 2012, 95(2):88–97.
Anthony L B, Strosberg J R, Klimstra D S, et al. The NANETS consensus guidelines for the diagnosis and management of gastrointestinal neuroendocrine tumors (NETS): well-differentiated NETS of the distal colon and rectum. Pancreas, 2010, 39(6):767–774.
Ramage J K, Ahmed A, Ardill J, et al. Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours (NETs). Gut, 2012, 61(1):6–32.
National Comprehensive Cancer Network (NCCN). NCCN practice guidelines for neuroendocrine tumors [EB/OL]. [2011-07-25] http://www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf.
Kasuga A, Chino A, Uragami N, et al. Treatment strategy for rectal carcinoids: a clinicopathological analysis of 229 cases at a single cancer institution. J Gastroenterol Hepatol, 2012, 27(12):1801–1807.
Kim B N, Sohn D K, Hong C W, et al. Atypical endoscopic features can be associated with metastasis in rectal carcinoid tumors. Surg Endosc, 2008, 22(9):1992–1996.
Shimizu T, Tanaka S, Haruma K, et al. Growth characteristics of rectal carcinoid tumor. Oncology, 2000, 59(3):229–237.
Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ, 2005, 330(7491):565.
Konishi T, Watanabe T, Kishimoto J, et al. Prognosis and risk factors of metastasis in colorectal carcinoids: results of a nationwide registry over 15 years. Gut, 2007, 56(6):863–868.
Tsukamoto S, Fujita S, Yamaguchi T, et al. Clinicopathological characteristics and prognosis of rectal well-differentiated neuroendocrine tumors. Int J Colorectal Dis, 2008, 23(11):1109–1113.
Fujimoto Y, Oya M, Kuroyanagi H, et al. Lymph-node metastases in rectal carcinoids. Langenbecks Arch Surg, 2010, 395(2):139–142.
Lee J B. Clinical characteristics of colorectal carcinoid tumors. Journal of the Korean Society of Coloproctology, 2011, 27(1):17–20.
Yamagishi D, Matsubara N, Noda M, et al. Clinicopathological characteristics of rectal carcinoid patients undergoing surgical resection. Oncology Letters, 2012, 4(5):910–914.
Bosman FT, Carneim F, Hruban RH, et al. WHO classification of tumours of the digestive system. Lyon: IARC. 2010.
Glasgow S C, Bleier J I, Burgart L J, et al. Meta-analysis of histopathological features of primary colorectal cancers that predict lymph node metastases. J Gastrointest Surg, 2012, 16(5):1019–1028.
Bipat S, Glas A S, Slors F J, et al. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis. Radiology, 2004, 232(3):773–783.
Al-Sukhni E, Milot L, Fruitman M, et al. Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol, 2012, 19(7):2212–2223.
Modlin I M, Oberg K, Chung D C, et al. Gastroenteropancreatic neuroendocrine tumours. Lancet Oncol, 2008, 9(1):61–72.
Ishii N, Horiki N, Itoh T, et al. Endoscopic submucosal dissection and preoperative assessment with endoscopic ultrasonography for the treatment of rectal carcinoid tumors. Surg Endosc, 2010, 24(6):1413–1419.
Shim K N, Yang S K, Myung S J, et al. Atypical endoscopic features of rectal carcinoids. Endoscopy, 2004, 36(4):313–316.
Hotta K, Shimoda T, Nakanishi Y, et al. Usefulness of Ki-67 for predicting the metastatic potential of rectal carcinoids. Pathol Int, 2006, 56(10):591–596.
Author information
Authors and Affiliations
Corresponding author
Appendix
Appendix
Rights and permissions
About this article
Cite this article
Zhou, X., Xie, H., Xie, L. et al. Factors Associated with Lymph Node Metastasis in Radically Resected Rectal Carcinoids: a Systematic Review and Meta-analysis. J Gastrointest Surg 17, 1689–1697 (2013). https://doi.org/10.1007/s11605-013-2249-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-013-2249-7