Carcinoid of the Rectum Risk Stratification (CaRRs): A Strategy for Preoperative Outcome Assessment

Fahy, Bridget N.; Tang, Laura H.; Klimstra, David S.; Wong, W. Douglas; Guillem, José G.; Paty, Philip B.; Temple, Larissa K.; Shia, Jinru; Weiser, Martin R.

doi:10.1245/s10434-006-9311-6

Cited by 89 publications

(83 citation statements)

References 11 publications

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“…For the lower jejunum and ileum, the size limits indicated for T1 and T2 are those defined for tumors of "benign behavior" and "uncertain behavior," respectively, according to the WHO site-specific clinicopathological correlations [5,8,34]. For the appendix and colon and rectum tumors, lower size limits were defined for T1 and T2 based on current data [6,15,29]. For colon and rectum tumors, T1 was divided into T1A and T1B based on current information on the biology of tumors below 1 cm in size and between 1 and 2 cm [6].…”

Section: Tnm Staging Proposalmentioning

confidence: 99%

“…For the appendix and colon and rectum tumors, lower size limits were defined for T1 and T2 based on current data [6,15,29]. For colon and rectum tumors, T1 was divided into T1A and T1B based on current information on the biology of tumors below 1 cm in size and between 1 and 2 cm [6].…”

Section: Tnm Staging Proposalmentioning

confidence: 99%

“…Grading Studies on well-differentiated NETs of midgut and hindgut origin have shown the usefulness of a grading system (see Table 7) [6,35,36]. Well-differentiated endocrine tumors with proliferative activity greater than 2%, but below that usually found in poorly differentiated endocrine carcinomas, may have a prognosis intermediate between the "2% NETs" and poorly differentiated carcino- mas [18-20, 23, 24].…”

Section: Grading Proposalmentioning

confidence: 99%

“…Given their rarity [10,[14][15][16][17], correct diagnosis and appropriate treatment are often difficult in nonexpert settings and even for appendiceal "carcinoids," probably the best known GEP-NETs with the most benign behavior [31]. Recent data on ileal, appendiceal, and rectal carcinoids, also indicated several variables influencing survival and prognosis [6,15,29,35].…”

Section: Introductionmentioning

confidence: 99%

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TNM staging of midgut and hindgut (neuro) endocrine tumors: a consensus proposal including a grading system

et al. 2007

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Criteria for the staging and grading of neuroendocrine tumors (NETs) of midgut and hindgut origin were established at the second Consensus Conference in Frascati (Rome) organized by the European Neuroendocrine Tumor Society (ENETS). The proposed tumor-node-metastasis (TNM) classifications are based on the recently published ENETS Guidelines for the Diagnosis and Treatment of gastroenteropancreatic NETs and follow our previous proposal for foregut tumors. The new TNM classifications for NETs of the ileum, appendix, colon, and rectum, and the grading system were designed, discussed, and consensually approved by all conference participants. These proposals need to be validated and are meant to help clinicians in the stratification, treatment and follow-up of patients.

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Section: Tnm Staging Proposalmentioning

confidence: 99%

Section: Tnm Staging Proposalmentioning

confidence: 99%

Section: Grading Proposalmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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TNM staging of midgut and hindgut (neuro) endocrine tumors: a consensus proposal including a grading system

et al. 2007

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“…The authors observed a strong association of the presence of lymphovascular invasion with metastasis and poor relapse-free and disease-specific survival (16,17). When selecting the appropriate treatment, it is often particularly difficult to evaluate NETs sized <20 mm in the clinical setting.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of treatment for rectal neuroendocrine tumors sized under 20 mm in comparison with the WHO 2010 guidelines

Matsuhashi

Takahashi

Tomita

et al. 2017

Molecular and Clinical Oncology

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Abstract. Rectal neuroendocrine tumor (NET) is a relatively rare lesion of the gastrointestinal tract, but the prospective examination with colonofiberoscopy or endoscopic ultrasound has increased the frequency of its detection. It is often difficult to determine the optimal treatment for NETs sized <20 mm in the clinical setting. Other clinicopathological variables are not considered in the current guidelines and staging systems. Although the effects of lymphovascular invasion are not covered by the World Health Organization (WHO) 2010 guidelines or tumor-node-metastasis (TNM) staging system, this may be promising for the establishment of improved guidelines and staging systems, particularly for early-stage colorectal carcinoids. The aim of the present study was to evaluate rectal NETs sized <20 mm in comparison with the WHO 2010 guidelines. Between January 2005 and December 2013, 40 consecutive patients [26 men and 14 women; median age, 59.3 years (range, 34-81 years)] who underwent endoscopic resection of rectal NETs, and 12 patients undergoing surgical resection of rectal NETs, were enrolled in this retrospective study. The median tumor size was 7.4 mm (range, 3-15 mm). The locations of the NET were the rectosigmoid colon (n=3), the upper rectum (n=13), and the lower rectum (n=25). The NETs were classified by size as 0-5 (n=7), 6-10 (n=29) and 11-15 mm (n=4). The surgical procedures performed included low anterior resection plus esophagectomy (n=1), laparoscopic low anterior resection (n=7) and laparoscopic intersphincteric resection (n=4). Only 1 patient had lymph node metastasis (tumor sized 6-10 mm, with lymphovascular invasion). NET recurrence was not detected in any of the patients. According to the WHO guidelines, the tumors were classified as grade (G)1 (n=8), G2 (n=3) and G1/G2 (n=1). The tumor in the patient with lymph node metastasis was G1. NETs sized <10 mm may be curatively treated by endoscopic resection. However, NETs with either lymphovascular invasion or sized >1 cm carry a risk for metastasis equivalent to that of adenocarcinomas. Therefore, it is mandatory to histologically examine lymphovascular invasion in specimens retrieved via endoscopic resection to determine the necessity for further radical surgery with regional lymph node dissection. The treatment of NETs sized <20 mm as presently defined in the WHO 2010 guidelines requires further evaluation.

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Endoscopic Ultrasonography

Khashab¹,

Canto²

2015

Yamada' S Textbook of Gastroenterology

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Carcinoid of the Rectum Risk Stratification (CaRRs): A Strategy for Preoperative Outcome Assessment

Cited by 89 publications

References 11 publications

TNM staging of midgut and hindgut (neuro) endocrine tumors: a consensus proposal including a grading system

TNM staging of midgut and hindgut (neuro) endocrine tumors: a consensus proposal including a grading system

Evaluation of treatment for rectal neuroendocrine tumors sized under 20 mm in comparison with the WHO 2010 guidelines

Endoscopic Ultrasonography

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