Surgery for Rectal Carcinoids of 1-2 cm in Diameter in 31 Patients

  Objective  To investigate the clinical features of and surgical choices for rectal carcinoids of 1-2 cm in diameter.

  Methods  The clinical data of 31 rectal carcinoid patients with tumors of 1-2 cm in diameter who were treated in Peking Union Medical College Hospital between January 2000 and December 2012 were collected and analyzed retrospectively. The selected patients included 17 males and 14 females, aged 24-77 years (median age 46 years).

  Results  Abdominal discomfort and diarrhea(18/31, 58.1%) were the most common symptoms. Two(2/31, 6.5%) patients had hematochezia. The other 11 were asymptomatic. Twenty-six patients underwent local excision: transanal endoscopic microsurgery (TEM) in 19 (61.3%), transsphincteric resection (York-Mason approach) in 4(12.9%), and transanal excision in 3(9.7%).Five (16.1%) patients received radical surgery. Postoperative pathological results showed rectal carcinoid in all the 31 patients, including limited submucosal lesions in 25 cases and muscular invasion in 6. Lymph node metastasis occurred in 1 case. Among the 29 patients who were followed up, the 23 patients with limited submucosal lesions had a 5-year survival rate of 95.7%, significantly higher than that of the 6 patients with muscular invasion(50%, P < 0.001).

  Conclusion  For the rectal carcinoid tumors of 1-2 cm in diameter without muscular invasion, local excision is an appropriate surgical choice; while for those with muscular invasion, radical resection is necessary.