Waisberg Daniel Reis, Fava Antonio Sergio, Martins Lourdes Conceição, Matos Leandro Luongo, Franco Maria Isete Fares, Waisberg Jaques
Departments of Surgery, Hospital do Servidor Público Estadual, São Paulo, SP, Brazil.
Arq Gastroenterol. 2009 Oct-Dec;46(4):288-93. doi: 10.1590/s0004-28032009000400008.
Colonic carcinoids, excluding those arising in the appendix, have proved to be extremely rare. Due to their rarity, the characteristics and behavior of this unusual malignancy remain unclear.
To review the clinicopathologic features of patients operated on carcinoid tumors of the colon.
Twenty-three patients (12 males and 11 females) were operated on colonic carcinoids. The mean age of the patients was 63.0 +/- 12.9 years (42 to 85 years). The clinical and histopathological data of patients who were pathologically diagnosed as having carcinoid tumors and submitted to surgical treatment over a 30-year period (1977-2007) were gathered. Actuarial patient survival was estimated using the Kaplan-Meier method, with carcinoid-specific death as the outcome.
The mean time elapsed between onset of symptoms and surgical treatment was 8.3 months (1.5 to 20 months). The most frequent symptoms or signs encountered were abdominal pain followed by anorexia or weight loss, diarrhea, abdominal tenderness, palpable abdominal mass, and rectal bleeding. No carcinoid syndrome was noted. The lesion was located in the cecum in 16 (69.6%) patients, in the sigmoid in 3 patients (13.0%), in the ascending colon in 3 patients (13.0%), and in the transverse colon in one patient (4.3%). Twenty-one (91.3%) patients were operated on curative intent. Spreading of the disease to the liver and peritoneum was found in two (8.7%) patients who submitted to intestinal bypass. The mean size of the largest mass was 3.7 +/- 1.2 cm (1.5 to 6.2 cm). There were multiple (two or more) lesions in three cases (13.0%). In the resected cases, the lymph nodes were compromised in 10 patients (47.6%) and disease-free in 11 (52.4%). Venous invasion and neural infiltration were both present in five (23.8%) patients. The tumors had penetrated the muscularis propria in all resected cases. Four (17.4%) patients had a second non-carcinoid primary tumor. Three (13.0%) patients died due to postoperative complications and five (21.7%) patients died from metachronous metastases or local recurrence. Fifteen patients (65.2%) remain alive without evidence of active disease. The mean follow-up period was 12 years (1.2 to 18 years), whereas the mean global survival was 50.7 +/- 34.2 months and the crude survival rate at 5 years was 62.7%.
Carcinoid tumors of the colon are frequently right-sided and may be clinically occult until an advanced stage is reached. Based on the relatively poor survival rates reported, it is recommended that, in addition to standard surgical resection, vigorous surveillance for metastatic disease must be performed, particularly during the first 2 years after surgery. In addition, these patients require evaluation of the entire gastrointestinal tract for evidence of coexisting malignancy, along with an extended period of follow-up, because tumor recurrences after 5 years are not uncommon.
除阑尾类癌外，结肠类癌极为罕见。因其罕见性，这种不寻常恶性肿瘤的特征和行为仍不明确。
回顾接受结肠类癌手术患者的临床病理特征。
23例（12例男性和11例女性）患者接受了结肠类癌手术。患者的平均年龄为63.0±12.9岁（42至85岁）。收集了在30年期间（1977 - 2007年）经病理诊断为类癌肿瘤并接受手术治疗患者的临床和组织病理学数据。采用Kaplan - Meier方法估计患者精算生存率，以类癌特异性死亡为结局。
症状出现至手术治疗的平均时间为8.3个月（1.5至20个月）。最常见的症状或体征依次为腹痛，其次是厌食或体重减轻、腹泻、腹部压痛、可触及的腹部肿块和直肠出血。未发现类癌综合征。病变位于盲肠16例（69.6%），乙状结肠3例（13.0%），升结肠3例（13.0%），横结肠1例（4.3%）。21例（91.3%）患者接受了根治性手术。2例（8.7%）接受肠旁路手术的患者出现疾病扩散至肝脏和腹膜。最大肿块的平均大小为3.7±1.2 cm（1.5至6.2 cm）。3例（13.0%）有多个（两个或更多）病变。在切除病例中，10例（47.6%）患者的淋巴结受累，11例（52.4%）无病。5例（23.8%）患者同时存在静脉侵犯和神经浸润。所有切除病例中肿瘤均穿透固有肌层。4例（17.4%）患者有第二个非类癌原发性肿瘤。3例（13.0%）患者死于术后并发症，5例（21.7%）患者死于异时性转移或局部复发。15例（65.2%）患者存活且无疾病活动证据。平均随访期为12年（1.2至18年），而平均总生存期为50.7±34.2个月，5年粗生存率为62.7%。
结肠类癌常位于右侧，在晚期之前可能临床上隐匿。基于所报道的相对较差的生存率，建议除标准手术切除外，必须对转移性疾病进行积极监测，尤其是在术后的头2年。此外，这些患者需要评估整个胃肠道以寻找并存恶性肿瘤的证据，并进行延长的随访期，因为5年后肿瘤复发并不罕见。
