CARCINOID-TUMORS OF THE RECTUM - EFFECT OF SIZE, HISTOPATHOLOGY, AND SURGICAL-TREATMENT ON METASTASIS FREE SURVIVAL

BACKGROUND. The purpose of this study was to determine the clinical co urse, effects of specific tumor histopathologic characteristics, and e xtent of surgical treatment on the metastatic rate in patients with re ctal carcinoids. METHODS. Medical records of 44 patients who presented with rectal carcinoids were retrospectively reviewed. Primary tumors were classified by size (<1 cm, 1-2 cm, and >2 cm), and tumor histopat hologic features (atypical or typical). Extensive surgery was defined as abdominoperineal or low anterior resection of the rectum or laparot omy with intent of curative resection. RESULTS. Median follow-up for p atients who presented without metastasis was 84 months. Thirteen of ti le 44 patients (30%) presented with metastatic disease. The 5-year met astasis free survival rates for those patients presenting without meta static disease were 100% for patients with tumors <1 cm (n = 16), 73% for those with tumors 1-2 cm (n = 8), and 25% for those with tumors >2 cm (n = 4) (P = 0.04 comparing <1 cm with 1-2 cm and P = 0.05 compari ng 1-2 cm with >2 cm); tumor size data were not available for 3 patien ts. The 5-year metastasis free survival rate for patients presenting w ithout metastatic disease with typical histology (n = 20), regardless of size, was 100%, compared with 50% for patients with tumors with aty pical histology (n = 11) (P = 0.001). Nine patients underwent extensiv e surgery for rectal carcinoid tumors but no survival benefit was demo nstrated. CONCLUSIONS. Atypical histopathologic features and a tumor s ize >1 cm are associated with aggressive behavior of rectal carcinoid tumors. Extensive surgery offers no survival advantage over local exci sion for patients with rectal carcinoid tumors. (C) 1997 American Canc er Society.