Sauven P, Ridge J A, Quan S H, Sigurdson E R
Colorectal Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Ann Surg. 1990 Jan;211(1):67-71. doi: 10.1097/00000658-199001000-00012.
The management of large carcinoid tumors of the anorectum is controversial. Most carcinoid tumors of the rectum and anus are early lesions, adequately treated by local excision. However, because of their relative rarity, the number of advanced cases seen at most institutions is small. Forty-three patients with anorectal carcinoid tumors were treated at our institution between 1960 and 1988 with complete follow-up. The median age of onset was 56 years. Eleven patients had no symptoms and the tumor was detected incidentally in eight additional patients with other diseases. Twenty tumors were larger than 2 cm in diameter and all patients had symptoms. Eight patients had another malignancy and three patients had ulcerative colitis. An association between ulcerative colitis and rectal carcinoid tumors is not widely appreciated. Eighteen tumors were treated by local excision, 16 by radical surgery, and nine underwent only biopsy. With complete resection of the primary lesion, local recurrence was never a problem. The median survival from diagnosis was 38 months in this series and 23 patients died of disease. After detection of metastases, the median survival time was 10 months. Tumors more advanced that T2 or larger than 2 cm in diameter were always fatal. All 13 patients with involved lymph nodes died of metastatic disease, with a median survival of 10 months, although one lived 9 years. Advanced rectal carcinoid tumors are aggressive malignancies. Adequate local excision controls regional disease but rectal carcinoid tumors are cured only when they are discovered before the T3 stage, measure less than 2 cm in diameter, and when lymph nodes are not involved. Consequently if a local excision permits complete resection, radical extirpative surgery will provide little benefit.
直肠肛管大类癌肿瘤的治疗存在争议。大多数直肠和肛管类癌肿瘤为早期病变，通过局部切除即可得到充分治疗。然而，由于其相对罕见，大多数机构所见的晚期病例数量较少。1960年至1988年间，我院共治疗了43例直肠肛管类癌肿瘤患者，并进行了完整的随访。发病的中位年龄为56岁。11例患者无症状，另外8例患有其他疾病的患者是偶然发现肿瘤的。20个肿瘤直径大于2cm，所有患者均有症状。8例患者患有其他恶性肿瘤，3例患者患有溃疡性结肠炎。溃疡性结肠炎与直肠类癌肿瘤之间的关联尚未得到广泛认识。18个肿瘤通过局部切除治疗，16个通过根治性手术治疗，9个仅接受了活检。随着原发病变的完全切除，局部复发从未成为问题。该系列患者从诊断开始的中位生存期为38个月，23例患者死于该疾病。发现转移后，中位生存时间为10个月。超过T2期或直径大于2cm的更晚期肿瘤总是致命的。所有13例有淋巴结受累的患者均死于转移性疾病，中位生存期为10个月，尽管有1例存活了9年。晚期直肠类癌肿瘤是侵袭性恶性肿瘤。充分的局部切除可控制局部疾病，但直肠类癌肿瘤只有在T3期之前被发现、直径小于2cm且无淋巴结受累时才能治愈。因此，如果局部切除能够实现完全切除，根治性切除手术几乎不会带来益处。
