Wei Rockson, Lo Oswens S H, Law Wai Lun
Division of Colorectal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong.
World J Surg Oncol. 2015 Feb 7;13:31. doi: 10.1186/s12957-015-0463-3.
Rectal carcinoids are an uncommon entity comprising only 1%-2% of all rectal tumors. Rectal carcinoids are frequently diagnosed during colonoscopy, but management after polypectomy is still controversial. The aims of this study were to review the surgical procedures for rectal carcinoids and to compare the outcomes of patients after different treatment modalities in a university hospital in Hong Kong.
All rectal carcinoids diagnosed between January 2003 and September 2012 were reviewed retrospectively, including clinicopathological characteristics, their management, and surgical outcomes.
There were 54 patients with a median age of 60 years, and 32 were males (59.3%). All patients underwent colonoscopy, and the most had rectal bleeding (53.7%). Two patients were diagnosed incidentally in the surgical specimens of rectal tissues. Eighteen patients were diagnosed to have rectal carcinoids after snaring polypectomy, and no further intervention was required. Twenty-five patients had local resection either by means of transanal resection or transanal endoscopic operation. Radical resection was performed in seven patients in which one had T3N1 disease and the others did not have any lymph node metastasis. In the median follow-up of 30 months (10-108 months), there was no recurrence in the "incidental" or post-polypectomy group. However, two patients with transanal resection and two patients with radical resection developed hepatic metastases after 13-24 months post-treatment. The 5-year overall survival was 100% in patients having snaring polypectomy only, 83% for those with local resection, and 63% in patients who underwent radical surgery (p = 0.04).
Our data suggested that that local resection was an effective treatment for small rectal carcinoids and generally brought about good oncological and surgical outcomes. For larger tumors, radical resection seemed to provide acceptable oncological outcomes. Regular surveillance with colonoscopy and endorectal ultrasound is highly recommended for high-risk patients for long-term management. By sharing our experience, we hope to provide more evidence on the management on rectal carcinoids which, together with evidence from further studies, may guide us in the long-term management of these patients in the future.
直肠类癌是一种罕见的疾病，仅占所有直肠肿瘤的1%-2%。直肠类癌常在结肠镜检查时被诊断出来，但息肉切除术后的处理仍存在争议。本研究的目的是回顾直肠类癌的手术方法，并比较香港一家大学医院中不同治疗方式患者的治疗结果。
回顾性分析2003年1月至2012年9月期间诊断的所有直肠类癌患者，包括临床病理特征、治疗方法及手术结果。
共54例患者，中位年龄60岁，男性32例（59.3%）。所有患者均接受了结肠镜检查，多数患者有直肠出血（53.7%）。2例在直肠组织手术标本中偶然诊断。18例患者在圈套息肉切除术后被诊断为直肠类癌，无需进一步干预。25例患者通过经肛门切除或经肛门内镜手术进行了局部切除。7例患者进行了根治性切除，其中1例为T3N1疾病，其余患者无淋巴结转移。中位随访30个月（10-108个月），“偶然发现”或息肉切除术后组无复发。然而，2例经肛门切除患者和2例根治性切除患者在治疗后13-24个月出现肝转移。仅行圈套息肉切除术的患者5年总生存率为100%，局部切除患者为83%，接受根治性手术的患者为63%（p = 0.04）。
我们的数据表明，局部切除是小直肠类癌的有效治疗方法，通常能带来良好的肿瘤学和手术效果。对于较大的肿瘤，根治性切除似乎能提供可接受的肿瘤学结果。强烈建议对高危患者进行定期结肠镜检查和直肠内超声监测，以进行长期管理。通过分享我们的经验，我们希望为直肠类癌的治疗提供更多证据，这些证据与进一步研究的证据一起，可能会在未来指导我们对这些患者进行长期管理。
