Endoscopic submucosal dissection versus transanal local excision for rectal carcinoid: a comparative study.
OBJECTIVE
The aim of this study is to compare the short-term clinical outcomes between endoscopic submucosal dissection and transanal local excision for rectal carcinoid tumors.


METHODS
Between 2007 and 2012, 31 patients with rectal carcinoid underwent endoscopic submucosal dissection at our hospital. They were compared with a matched cohort of 23 patients who underwent transanal local excision for rectal carcinoid between 2007 and 2012. Short-term clinical outcomes including surgical parameters, postoperative recovery, and oncologic outcomes were compared between the two groups.


RESULTS
The mean size of tumors was significantly bigger in the transanal local excision group (0.8 ± 0.2 versus 1.1 ± 0.5 cm; P = 0.018). En bloc resection was achieved for 30 patients (97 %) in the endoscopic submucosal dissection group and all the patients in the transanal local excision group. The operation time was longer in the transanal local excision than that in the endoscopic submucosal dissection group (40.0 ± 22.7 min versus 12.2 ± 5.3 min; P < 0.001). Complications in the transanal local excision group were five cases of acute retention of urine. There was no local recurrence or distant metastasis in either group during the follow-up period.


CONCLUSIONS
For the treatment of rectal carcinoid tumors with diameter <1 cm, endoscopic submucosal dissection has better short-term clinical outcomes than transanal local excision in terms of faster recovery and possibly a lower morbidity rate. Transanal local excision may be the first therapeutic choice of scar-embedded rectal carcinoid tumors.
Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Changhai Road 168#, Shanghai, China.|Department of General Surgery, 413 Hospital, Zhoushan, China.
Fei-Hu
FH
Yan
Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Changhai Road 168#, Shanghai, China.
Zheng
Z
Lou
Department of Colorectal Surgery, Jianmin Colorectal Disease Hospital, Yong gang South Road 225#, Ningbo, China.
Shi-Jie
SJ
Hu
Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Changhai Road 168#, Shanghai, China.
Xiao-Dong
XD
Xu
Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Changhai Road 168#, Shanghai, China.
Hao
H
Wang
Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Changhai Road 168#, Shanghai, China.
Han-Tao
HT
Wang
Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Changhai Road 168#, Shanghai, China.
Rong-Gui
RG
Meng
Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Changhai Road 168#, Shanghai, China.
Chuan-Gang
CG
Fu
Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Changhai Road 168#, Shanghai, China.
Wei
W
Zhang
Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Changhai Road 168#, Shanghai, China.
Jian
J
He
Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Changhai Road 168#, Shanghai, China. fei1989hu@163.com.
En-da
ED
Yu
D002276:Carcinoid Tumor / Q000473:pathology / Q000601:surgery*; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D000067368:Transanal Endoscopic Surgery / Q000379:methods*
Endoscopic submucosal dissection; Rectal carcinoid; Transanal local excision