Endoscopic Resection for Rectal Carcinoid Tumor: Efficacy and Clinical Results of Follow-up

Kim, Gwang Un; Ye, Byong Duk; Byeon, Jeong Sik; Park, Hwan Sung; Ok, Tae Jin; Yang, Dong Hoon; Jung, Kee Wook; Kim, Kyung Jo; Myung, Seung Jae; Yang, Suk Kyun; Kim, Jin Ho

Abstract

BACKGROUND/AIMS
With the growing volume of screening colonoscopies, the incidence of rectal carcinoids and the number of endoscopic resections for rectal carcinoids are also increasing. However, the prognosis including recurrence and metachronous lesions after endoscopic resection is unclear.
METHODS
The medical records of 255 patients who had undergone endoscopic resection for rectal carcinoids between October 1999 and April 2010 were retrospectively reviewed.
RESULTS
The number of males was 150 (58.8%), and the mean age was 54.1 years (range, 27-85 years). Mean tumor size was 6.9 mm. In total, 162 cases (63.5%) were treated with endoscopic mucosal resection and 93 (36.5%) were treated with endoscopic submucosal dissection. Although endoscopic complete resections were achieved in all cases, the histological examination showed 47 cases with a positive resection margin (18.4%) and three with lymphovascular invasion (1.2%). In the 54 patients with a free resection margin, who were followed for more than 12 months, abdominopelvic computed tomography and endoscopy did not show recurrence after a median of 30.5 and 36 months, respectively. Three patients with lymphovascular invasion did not show recurrence during follow-up period of 13, 30, and 37 months, respectively. Metachronous rectal carcinoids were detected in four patients at 23, 58, 61, and 89 months, respectively, after initial endoscopic resection, leading to a second endoscopic treatment.
CONCLUSIONS
Small rectal carcinoids completely resected grossly and pathologically without lymphovascular invasion appear to have low probability of short-term recurrence. However, considering the slow growth rate of carcinoids, long-term follow-up for recurrence and metachronous carcinoids is required.