Tomoda H, Furusawa M, Hayashi I, Okumura K
Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan.
Jpn J Surg. 1990 Jul;20(4):468-71. doi: 10.1007/BF02470834.
We report herein, a patient with a rectal carcinoid tumor of less than 1 cm in diameter with lymph node metastasis, and discuss a surgical policy for these lesions with reference to other such cases reported in the literature. A 40 year old female was admitted with a rectal mass and colonoscopy revealed a subpedunculated lesion, 1 cm in diameter, with a depression in its tip. A diagnosis of carcinoid was made by biopsy and transsacral excision performed. The excised specimen revealed a subpedunculated lesion measuring 7 X 6 X 6 mm with a central depression. The tumor was histologically confined to the submucosa but lymphatic invasion with pararectal lymph node involvement was observed. A radical proctectomy was thus performed. The incidence of metastasis from rectal carcinoids with a diameter of 1 cm or less is very low ranging from 1.5 to 3.4 per cent, and it therefore seems that most lesions of 1 cm or less in diameter can be treated by local excision alone. Thus, although it is recommended that local excision be performed first to determine the extent of spread, lymphatic vessel invasion and lymph node metastasis, radical surgery is indicated if lymphatic invasion or nodal involvement is present, even when muscle invasion is absent.
我们在此报告一例直径小于1 cm且伴有淋巴结转移的直肠类癌患者，并参考文献中报道的其他此类病例讨论这些病变的手术策略。一名40岁女性因直肠肿物入院，结肠镜检查发现一个有蒂的病变，直径1 cm，顶端有凹陷。活检诊断为类癌，并进行了经骶骨切除术。切除标本显示一个有蒂的病变，大小为7×6×6 mm，中央有凹陷。肿瘤组织学上局限于黏膜下层，但观察到有淋巴管侵犯及直肠旁淋巴结受累。因此进行了根治性直肠切除术。直径1 cm或更小的直肠类癌转移发生率非常低，为1.5%至3.4%，因此似乎大多数直径1 cm或更小的病变仅通过局部切除即可治疗。因此，尽管建议首先进行局部切除以确定扩散范围、淋巴管侵犯和淋巴结转移情况，但如果存在淋巴管侵犯或淋巴结受累，即使没有肌层侵犯，也应进行根治性手术。
