Center of Gastroenterology, Maebashi Red Cross Hospital, Maebashi, Japan.
Dis Colon Rectum. 2010 Feb;53(2):169-76. doi: 10.1007/DCR.0b013e3181b9db7b.
Various methods have been reported for the endoscopic treatment of rectal carcinoid tumors. The present study was designed to identify the optimal treatment strategy for an endoscopic resection.
Forty rectal carcinoid tumors of 38 patients were treated endoscopically. The indication criteria, complete resection rate, selection of treatment, local recurrence, distant metastases, and complications were analyzed. All tumors were estimated to measure 1 cm or less in diameter, without muscular invasion, atypical features, and lymph node metastases to the pararectal region.
Complete resection of the lesions was obtained in 75.0% (30/40). The complete resection rates were 20.0% (1/5) by conventional polypectomy, 84.6% (22/26) by a two-channel endoscopic mucosal resection, and 77.8% (7/9) by endoscopic submucosal dissection. The 10 cases that did not show a clear submucosal layer after initial endoscopic treatment received additional endoscopic microwave coagulation therapy. There were no local or distant recurrences in the followed-up periods (median, 6.4 years). No difference was observed in the complete resection rate between two-channel endoscopic mucosal resection and endoscopic submucosal dissection.
Small carcinoid tumors measuring less than 1 cm in diameter can therefore be managed endoscopically with no recurrence or spread. The selection of endoscopic treatment should be made after taking such factors as cost-effectiveness, expertise, and experience into careful consideration.
各种方法已被报道用于直肠类癌肿瘤的内镜治疗。本研究旨在确定内镜切除的最佳治疗策略。
对 38 例 40 个直肠类癌肿瘤患者进行了内镜治疗。分析了适应证标准、完全切除率、治疗选择、局部复发、远处转移和并发症。所有肿瘤估计直径为 1cm 或更小，无肌层侵犯、非典型特征和腹膜后淋巴结转移。
75.0%（30/40）获得了病变的完全切除。常规息肉切除术的完全切除率为 20.0%（1/5），双腔内镜黏膜切除术为 84.6%（22/26），内镜黏膜下剥离术为 77.8%（7/9）。10 例初次内镜治疗后未见明显黏膜下层的患者接受了额外的内镜微波凝固治疗。随访期间无局部或远处复发（中位随访时间为 6.4 年）。双腔内镜黏膜切除术和内镜黏膜下剥离术的完全切除率无差异。
因此，直径小于 1cm 的小类癌肿瘤可以通过内镜治疗而无复发或扩散。内镜治疗的选择应在充分考虑成本效益、专业知识和经验等因素后做出。
