Clinicopathological characteristics of rectal carcinoids.
OBJECTIVE
Carcinoids are heterogeneous neuroendocrine tumors with malignant potential. The rectum is the third most common location for gastrointestinal carcinoids. We assessed the clinicopathological characteristics of rectal carcinoids.


METHODS
A retrospective study of 203 patients treated for rectal carcinoids at the Asan Medical Center, Seoul, Republic of Korea from 1991 to 2007.


RESULTS
The patients were on average 51 (18-83) years old. The male-to-female ratio was 1.48:1. Over half (62.1%) of the patients were asymptomatic. The most frequent symptoms in the symptomatic patients were abdominal pain (11.1%) and hematochezia (10.7%). Local excision was applied to 92.1%, low anterior resection to 4.9%, and biopsy only to 3.0% of total patients. Initially, 4.4% presented with distant metastasis. Distant metastasis rates for tumors < or =1 cm, >1 to < or =2 cm, and >2 cm were 1.7% (3/177), 15.0% (3/20), and 50.0% (3/6), respectively. In the follow-up period, three patients showed recurrences. The size, lymphovascular invasion, perineural invasion, and T and N stages were associated with distant metastasis. The overall 5-year survival rate was 94.0%. The TNM stage and presence of lymphovascular invasion were associated with lower survival.


CONCLUSIONS
The chance that a rectal carcinoid will develop distant metastases increases as the tumor increases in size, lymphovascular invasion or perineural invasion is present, and T and N stages increase. The TNM stage and presence of lymphovascular invasion were associated with lower survival. Treatment plan should be chosen carefully considering above factors.
Yoon
Sang Nam
SN
Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
Yu
Chang Sik
CS
Shin
Ui Sup
US
Kim
Chan Wook
CW
Lim
Seok-Byung
SB
Kim
Jin Cheon
JC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002276:Carcinoid Tumor / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D015996:Survival Rate; D055815:Young Adult
Surgery. 2008 Sep;144(3):460-6
18707046
Gut. 1996 Oct;39(4):562-8
8944566
Jpn J Surg. 1989 Sep;19(5):544-8
2593390
Cancer. 2003 Feb 15;97(4):934-59
12569593
J Nucl Med. 2002 Jul;43(7):889-95
12097458
Gastrointest Endosc. 2006 Feb;63(2):243-9
16427929
Cancer. 1997 Apr 1;79(7):1294-8
9083149
Best Pract Res Clin Gastroenterol. 2005 Aug;19(4):491-505
16183523
Cancer. 1997 Feb 15;79(4):813-29
9024720
Surg Endosc. 2005 Aug;19(8):1151-4
16021383
Oncology. 2000 Sep;59(3):229-37
11053991
Gastroenterology. 2005 May;128(6):1717-51
15887161
Cancer. 2005 Apr 15;103(8):1587-95
15742328
Surg Endosc. 2008 Sep;22(9):1992-6
18568372
Ann Surg. 2000 Oct;232(4):549-56
10998653
Ann Surg Oncol. 2007 May;14(5):1735-43
17294074