Treatment of rectal carcinoid tumors and role of preoperative imaging.

Abstract

3655 Background: To clarify the optimal management of rectal carcinoid tumors and role of preoperative imaging, retrospective analyses of prospectively accumulated data on treatment results and preoperative imaging were performed. Methods: Prospectively recorded clinicopathologic and imaging data of the 185 consecutive patients with rectal carcinoid tumors undergoing curative intent surgery between 1970 and 2006 were retrospectively analyzed. The recent 37 patients were examined preoperatively by transrectal ultrasonography (TRUS) or high-resolution magnetic resonance imaging (HRMRI). Results: There were 109 men and 76 women with a median age of 57 (range, 24-85) years. The patients were grouped according to tumor size: Group I, < 9 mm; Group II, 9-14 mm; Group III, > 14 mm. The clinicopathologic characteristics and treatment results are shown in the Table. Of the 37 patients examined by TRUS or HRMRI, 9 had invasion of the muscularis propria and 11 had regional lymph node metastasis. Sensitivity and specificity for detection of invasion of the muscularis propria were 100% and 100%, respectively. Sensitivity and specificity for detection of regional lymph node metastasis were 70% and 100%, respectively. Conclusions: Patients with carcinoid tumors measuring less than 9 mm can be treated with ER or LE alone; however, patients with tumors measuring 9 mm or larger should be first examined with TRUS or HRMRI and should be treated with ER or LE or RS according to the TRUS or HRMRI findings. Group No Invasion depth Metastasis Type of surgery 5-yr survival pT1 pT2-3 pN1-2 Liver ER LE RS HR I 120 120 0 0 0 91 20 9 0 100% II 49 44 5 11 1 21 16 12 1 96% III 16 8 8 5 5 3 6 7 5 66% Abbreviations: ER, endoscopic resection; LE, local excision; RS, radical surgery; HR, hepatic resection. No significant financial relationships to disclose.