Rectal carcinoids

Abstract

One hundred seventy patients with gastrointestinal carcinoid tumors were treated at Ochsner Clinic from 1958 to 1990. Ninety-four rectal carcinoid tumors were diagnosed and treated during this time. Carcinoid tumors of the rectum represented the most frequent primary site (55 percent), followed by carcinoids of the ileum (12 percent), appendix (12 percent), colon (6 percent), stomach (6 percent), jejunum (2 percent), pancreas (2 percent), and other (5 percent). One-half of rectal carcinoids were discovered during anorectal examination of asymptomatic patients. The remainder were found primarily by examination of patients for symptoms of benign anorectal conditions. The diagnosis of rectal carcinoid was made at the time of initial examination in 61 patients. This allowed definitive treatment in a single session by local excision and fulguration in 48 patients. The remainder were treated by repeat biopsy and fulguration (25 patients) or by transanal excision (12 patients). Overall, 85 carcinoid tumors of the rectum measuring less than 2 cm were treated by local excision and fulguration or by transanal excision, with an average five-year follow-up. There were no local recurrences. Ten patients with metastasizing rectal carcinoids averaging 4 cm were treated. All were symptomatic at presentation and fared poorly despite radical surgery. Three were alive at three years but only one survived five years. At our institution, rectal carcinoids were the most frequently detected carcinoid tumor. Small carcinoids of the rectum were adequately treated by local excision and fulguration or by transanal excision, with no local recurrence. The true incidence of rectal carcinoids is detected only with careful and complete rectal examination of the asymptomatic screening population by experienced surgeons. With more widespread screening of the well population, rectal carcinoids may become recognized as the most frequent human carcinoid tumor.

Carcinoid tumors of the rectum

“…Others have recommended extended resection However, if APR is required to resect the tumor, then quality of life issues must be considered prior to subfor primary tumors ú 2 cm without evidence of metastasis. 1,3,5 The authors do not support this recommenjecting the patient to a permanent colostomy even though they still have a high risk of recurrent disease. dation because in the current study all but 2 of the patients with tumors ú 2 cm developed metastatic…”

“…1,6,7 This observation may be due in part to the fact that The M. D. Anderson Cancer Center is a referral center; it is possible that a greater number or laparotomy for resection of the tumor (two paof patients with aggressive or atypical carcinoid tutients), all but one with curative intent. Both patients mors are referred.…”

“…1,2,3,5,15 Others have 5-Hydroxyindoleacetic Acid found that the different histologic growth patterns of Among 22 patients who had urinary 5-hydroxyindolecolonic carcinoids significantly influenced survival. 16 acetic acid (5-HIAA) levels measured, elevated levels…”

“…that are 1 -2 cm is unpredictable. 1,5 Reports indicate that carcinoid tumors 1 -2 cm are associated with a 10 -20% incidence of metastaAddress for reprints: Lee M. Ellis, M.D., Departsis. 1,6,7 The identification of factors that predict aggressive tumor be- The objectives of the current study were to determine 1) the natural history of rectal carcinoid tumors, 2) whether specific histo-…”

An Unusual Metastatic Motilin-Secreting Neuroendocrine Tumour with a 20-Year Survival

“…In a series of 98 rectal carcinoid tumours, 10 patients had metastases at diagnosis. Despite radical surgery, 3 were alive at 3 years and only 1 survived 5 years [7]. Factors influencing prognosis of NE tumours have been previously analyzed [8].…”