STAGE-DEPENDENT THERAPY OF RECTAL CARCINOID-TUMORS

Although malignant behavior of rectal carcinoid tumors is rare, the ri sk of metastases and death does exist. Adaptation of therapy according to the estimated malignancy seems necessary. To develop a stage-depen dent therapy, 31 patients with rectal carcinoid tumors measuring 5 to 50 mm in diameter were analyzed retrospectively. Malignancy mas estima ted according to tumor size, infiltration depth, and histopathology. T here were 18 tumors within the mucosa and submucosa (T1), 7 tumors wit h muscularis propria invasion (T2), and carcinoid tumor penetrating th e full rectal wall (T3) or spreading to surrounding tissue (T4) in 6 p atients. Altogether 20 patients (G5%) were treated with a minimally in vasive intervention: endoscopic polypectomy (EP) in 12 and transanal e xcision (TE) in 8 patients. In II patients (35%) aggressive surgical p rocedures-anterior resection (AR) in 4 and abdominoperineal resection (APR) in 7-were performed. After a mean +/- SD follow-up of 86.0 +/- 6 1.3 months, tumor recurrence was not seen in any of the 20 patients wi th minimally invasive treatment, and all were still alive. No severe c omplications associated with surgical procedures were detected. In con trast, 5 of the 10 patients with advanced tumor stage died from their disease despite aggressive surgery (AR, APR). In conclusion, depending on tumor stage, treatment of rectal carcinoids includes EP, TE, or ex tended resection. Minimally invasive techniques are safe treatments fo r small to medium-size T1/T2 rectal carcinoids. Extended surgery canno t improve the overall survival of those with advanced tumors (T3/T4, N 1, M1) but can be beneficial for preventing local complications.