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Rectal carcinoid tumors: review of results after endoscopic and surgical therapy
Mary R Kwaan, Joel E. Goldberg, Ronald Bleday
Brigham and Women's Hospital, Boston, MA

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 with well-differentiated neuroendocrine tumor (carcinoid tumor) of the rectum who were evaluated at our institution between 1990 and 2006.
Interventions:
Main Outcome Measures:
Margin status of tumor resection.
Results: Eighty-five patients were identified. Median age at diagnosis was 55 years. Thirty-three (39%) tumors were asymptomatic and diagnosed during screening colonoscopy. Eleven (13%) tumors were metastatic at presentation. 53% were <1.0 cm in size. Endoscopic therapy was performed in 46 (54%) patients. Thirty-eight (82%) had positive or indeterminate margins on histology, of whom six (16%) had residual tumor on subsequent endoscopy and one had recurrence as metastatic disease. One patient with a negative margin also recurred. Thirty-one (36%) patients underwent surgical resection: 74% transanal excision or endoscopic microsurgery, 19% low anterior resection and 6% abdominoperineal resection. Residual tumor was noted in 52 % of surgical specimens. Eight patients who did not receive local clearance of tumor had metastases on presentation, another active malignancy, or refused surgery. Patients undergoing endoscopic resection were more likely to have tumors <0.5 cm (35% vs. 7%), polypoid as opposed to nodular tumors (52% vs. 25%), and tumor limited to the mucosa (33% vs 7%). Amongst all patients, four metastases occurred during follow up, including two from tumors <1.0 cm at presentation.
Conclusions: Endoscopic treatment is sufficient for tumors that are small, limited to the mucosa, and where a margin is negative for tumor. Surgical resection should be considered for larger tumors that are nodular and invade beyond the mucosa.


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