Endoscopy 2011; 43(9): 790-795
DOI: 10.1055/s-0030-1256414
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Criteria for decision making after endoscopic resection of well-differentiated rectal carcinoids with regard to potential lymphatic spread

C.  H.  Park1 , J.  H.  Cheon2 , J.  O.  Kim3 , J.  E.  Shin4 , B.  I.  Jang5 , S.  J.  Shin6 , Y.  T.  Jeen7 , S.  H.  Lee8 , J.  S.  Ji9 , D.  S.  Han10 , S.  A.  Jung11 , D.  I.  Park12 , I.  H.  Baek13 , S.  H.  Kim14 , D.  K.  Chang15
  • 1Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
  • 2Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
  • 3Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soon Chun Hyang University Hospital, Seoul, Korea
  • 4Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
  • 5Department of Internal Medicine, Yeungnam University College of Medicine, Deagu, Korea
  • 6Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea
  • 7Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, Korea
  • 8Department of Internal Medicine, Soon Chun Hyang University Hospital, Cheonan, Korea
  • 9Department of Internal Medicine, Our Lady of Mercy Hospital, The Catholic University of Korea, Incheon, Korea
  • 10Department of Internal Medicine, Hanyang University Hospital, Kuri, Korea
  • 11Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
  • 12Department of Internal Medicine, SungKyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
  • 13Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
  • 14Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 15Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Further Information

Publication History

submitted 22 April 2009

accepted after revision 6 March 2011

Publication Date:
06 July 2011 (online)

Background and study aim: Rectal carcinoids are low-grade malignancies that are usually treated by endoscopic resection. However, on pathologic examination, resection margins that are positive for carcinoid cells are frequently found. Patient outcomes were reviewed after endoscopic resection of rectal carcinoids and the clinical significance of possible residual disease, as defined by pathologic and endoscopic examination, was evaluated.

Patients and methods: The medical records and endoscopic findings of 347 patients presenting with rectal carcinoids to 14 university hospitals in Korea between January 1999 and June 2007 were retrospectively analyzed.

Results: A total of 304 patients were treated with endoscopic resection, and 43 patents were treated with surgery. In the endoscopic resection group, the complete resection rate was 88.2 % based on endoscopic appearance (CR-E) and 60.2 % based on pathologic evaluation (CR-P). The agreement between CR-E and CR-P was low (κ = 0.192). No residual tumors were found in 77 of 85 patients (90.6 %) who were CR-E but not CR-P and who had endoscopic biopsy taken at 24-month follow-up. The receiver-operating characteristic curve identified an optimal cut-off value of 10.5 mm, at which the sensitivity and the specificity for metastasis were 100 % and 89 %, respectively. The risk factors for metastasis by multivariate analysis were tumor size, increased mitotic rate, and lymphovascular invasion.

Conclusions: Endoscopic resection is a safe and effective modality for treating well-differentiated rectal carcinoids smaller than 10 mm in diameter. Discrepancies were observed between CR-E and CR-P. The risk factors for metastasis were tumor size, increased mitotic rate, and lymphovascular invasion.

References

D. K. Chang, MD, PhD 

Division of Gastroenterology
Department of Internal Medicine
Samsung Medical Center
Sungkyunkwan University School of Medicine

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