Criteria for decision making after endoscopic resection of well-differentiated rectal carcinoids with regard to potential lymphatic spread

Park, C. H.; Cheon, Jae Hee; Kim, J. O.; Shin, J. E.; Jang, Byung-Ik; Shin, Samuel Jaeho; Jeen, Yoon-Tae; Lee, S. H.; Ji, Jeong‐Seon; Han, Dong Seok; Jung, Seulgi; Park, D. I.; Baek, Il Hyun; Kim, S. H.; Chang, Dong Kyung

doi:10.1055/s-0030-1256414

Cited by 117 publications

(129 citation statements)

References 22 publications

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“…This study included both endoscopically and surgically resected cases. Required follow-up duration in cases treated by ER or local resection in terms of confirming the absence of metastatic disease was assumed to be 24 months in minimum according to a previous study on rectal carcinoid [20]. Meanwhile, in surgically resected cases with LN dissection, the definition of no metastasis was histopathologically and radiologically proven cases during the follow-up period.…”

Section: Methodsmentioning

confidence: 99%

The Risk Factors for Metastasis in Non-Ampullary Duodenal Neuroendocrine Tumors Measuring 20 mm or Less in Diameter

et al. 2017

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Background/Aims: The treatment strategy for non-ampullary duodenal neuroendocrine tumors (NAD-NETs) ≤20 mm in diameter has not been established. In this study, we aimed to evaluate the detailed characteristics of NAD-NETs ≤20 mm in diameter to clarify the risk factors of subsequent metastasis. Methods: The patients with NAD-NETs ≤20 mm in diameter who had been treated at 12 institutions between 1992 and 2013 were enrolled. Clinical records were retrieved, and histopathological findings of all cases were centrally reviewed by 2 pathologists. Results: We studied 49 patients with a mean follow-up period of 66.5 months. Thirty-five patients were initially treated with endoscopic resection (ER), and 14 with surgery. A univariate analysis revealed the ORs and 95% CIs of the risk factors for metastasis were lymphovascular invasion (12.5 [2.01-77.9]), multiple tumors (9.75 [1.46-65.4]), a tumor size of 11-20 mm (6.67 [1.21-36.6]), and World Health Organization grade G2 (7.13 [1.16-43.9]). Five-year overall and disease-specific survival rates were 86.1 and 97.2%, respectively. Conclusion: This is the first study to demonstrate the risk factors of metastasis in NAD-NETs ≤20 mm in diameter. These findings may be helpful for determining the appropriate therapeutic approach and the clinical strategy of treatment following ER.

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Section: Methodsmentioning

confidence: 99%

The Risk Factors for Metastasis in Non-Ampullary Duodenal Neuroendocrine Tumors Measuring 20 mm or Less in Diameter

et al. 2017

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“…Microangioinvasion has been described as risk factor for metastases in rectal NETs [32]. In patients with pancreatic NET microangioinvasion was associated with higher risk of recurrence [33] and shorter long-term survival [34].…”

Section: Discussionmentioning

confidence: 99%

Well-Differentiated Neuroendocrine Neoplasia: Relapse-Free Survival and Predictors of Recurrence after Curative Intended Resections

Dieckhoff¹,

Runkel²,

Daniel³

et al. 2014

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Background: Resection with curative intention is the cornerstone of treatment in patients with neuroendocrine tumors. A proportion of patients will relapse after R0 resection, but the factors predictive of recurrence are not well understood. Methods: A database established 1998 at the University Hospital Marburg was queried for all patients with documented R0 resection. Recurrence-free survival and overall survival were estimated using the Kaplan-Meier method. Uni- and multivariate analyses were performed. Results: 180 patients with a median age of 52 years entered the analysis. We observed 77 recurrences after a median time of 2.9 years. 24% of the recurrences occurred later than 5 years after operation. Median recurrence-free survival of the whole cohort was 101 months. In univariate analysis grade by Ki-67, stage, high lymph node ratio and microangioinvasion were significant predictors of recurrence. On multivariate analysis these parameters were confirmed as independent prognostic parameters with stage and microangioinvasion being the most important predictors. Conclusions: After R0 resection of neuroendocrine tumors, postoperative surveillance should be extended to at least 10 years. Patients with distant metastases and microangioinvasion are at high risk of recurrence. Clinical trials of adjuvant treatment protocols are indicated in these patients.

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“…As regards the possibility of ESD treatment for carcinoid tumors, tumor size is considered to be the most important factor associated with the metastasis of rectal carcinoid tumors (23,24). Endoscopic treatment is considered to be curative for small carcinoid tumors (<10 mm) with an extremely low risk of metastasis (23,24).…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic treatment is considered to be curative for small carcinoid tumors (<10 mm) with an extremely low risk of metastasis (23,24). However, there is still some controversy over the optimal endoscopic method for the resection of rectal carcinoid tumors.…”

Section: Discussionmentioning

confidence: 99%

Indications of endoscopic submucosal dissection for symptomatic benign gastrointestinal subepithelial or carcinoid tumors originating in the submucosa

Kobara

Mori

Rafiq

et al. 2013

Molecular and Clinical Oncology

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Abstract. Endoscopic submucosal dissection (ESD) for upper gastrointestinal (GI) subepithelial tumors (SETs) originating in the muscularis propria (MP) layer is associated with numerous issues regarding secure closure and measures against accidental perforation. However, symptomatic benign GI SETs or carcinoid tumors originating in the submucosa (SM) may be safely resected en-bloc using ESD. In this study, the feasibility and safety of ESD as a novel method for endoscopic resection for such GI SETs revealed on endoscopic ultrasonography (EUS) was investigated. A total of 12 consecutive cases of patients with symptomatic benign SETs (n=3; 1 esophageal hemangioma and 2 gastric lipomas) or small carcinoid tumors (n=9; <10 mm, with an extremely low risk of metastasis) originating in the SM as determined on EUS, between March, 2009 and April, 2013, were retrospectively reviewed. The lesions were resected by ESD after confirming that the tumors originated from the SM. The complication rate following en-bloc resection was also determined. En-bloc resection was achieved in all 12 cases, the mean procedure time was 45 min (range, 20-120 min) and no complications occurred intra-or postoperatively. There was no tumor recurrence or disease-related mortality reported during the follow-up period (median follow-up time, 13.4 months). Histopathological curative resection was achieved with ESD without complications in all 9 cases with carcinoid tumors. Therefore, if EUS reveals a SET originating in the SM without infiltration of the MP and resection is indicated due to the presence of abdominal symptoms, ESD may be a feasible option for diagnostic treatment with minimal invasiveness. However, larger-scale prospective studies are required to establish the feasibility and safety of this procedure.

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Criteria for decision making after endoscopic resection of well-differentiated rectal carcinoids with regard to potential lymphatic spread

Abstract: Endoscopic resection is a safe and effective modality for treating well-differentiated rectal carcinoids smaller than 10 mm in diameter. Discrepancies were observed between CR-E and CR-P. The risk factors for metastasis were tumor size, increased mitotic rate, and lymphovascular invasion.

Cited by 117 publications

References 22 publications

The Risk Factors for Metastasis in Non-Ampullary Duodenal Neuroendocrine Tumors Measuring 20 mm or Less in Diameter

The Risk Factors for Metastasis in Non-Ampullary Duodenal Neuroendocrine Tumors Measuring 20 mm or Less in Diameter

Well-Differentiated Neuroendocrine Neoplasia: Relapse-Free Survival and Predictors of Recurrence after Curative Intended Resections

Indications of endoscopic submucosal dissection for symptomatic benign gastrointestinal subepithelial or carcinoid tumors originating in the submucosa

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