Endoscopic submucosal dissection versus transanal local excision for rectal carcinoid: a comparative study.

Fei-Hu Yan,Han-Tao Wang,Rong-Gui Meng,Jian He,Chuan-Gang Fu,En-Da Yu,Zheng Lou,Xiao-Dong Xu,Shi-Jie Hu,Wei Zhang,Hao Wang

doi:10.1186/s12957-016-0923-4

Abstract

AimThe aim of this study is to compare the short-term clinical outcomes between endoscopic submucosal dissection and transanal local excision for rectal carcinoid tumors.MethodsBetween 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.ResultsThe 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.ConclusionFor 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.

Highlights

Rectal carcinoid tumors account for 18.5 % of all carcinoid tumors
What does this paper add to the literature statement? In this work, we compare the short-term clinical outcomes between endoscopic submucosal dissection (ESD) and transanal local excision (TALE) for rectal carcinoid tumors, so as to help surgeons decide which method should be chosen for these patients
TALE approach must be performed with the patient under anesthesia, such as spinal anesthesia, Yan et al World Journal of Surgical Oncology (2016) 14:162 general endotracheal anesthesia (GETA), and IV sedation + local depending on tumor location and size, especially the characteristics and comorbidities of patients

Summary

Introduction

Rectal carcinoid tumors account for 18.5 % of all carcinoid tumors. these tumors represent only 1.3 %For rectal carcinoid tumors not amenable to conventional colonoscopic removal, the alternative treatment option is TALE procedure. Rectal carcinoid tumors account for 18.5 % of all carcinoid tumors. For rectal carcinoid tumors not amenable to conventional colonoscopic removal, the alternative treatment option is TALE procedure. This local procedure has proved to be safe and effective in the treatment of low rectal lesions. ESD is a novel colonoscopic method that enables en bloc resection for colorectal lesions. It can be performed with patients without anesthesia. The ESD approach has a reported perforation rate of 2 to 10 %, an en bloc resection rate of 80 to 90 %, and a short-term recurrence rate for colorectal ESD of 0 to 2.1 % [7]

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