EFFECTIVENESS OF LOCAL ENDOSCOPIC RESECTION OF RECTAL CARCINOID-TUMORS

Background and Study Aims: In the treatment of rectal carcinoid tumors , confusion arises in the choice between radical surgery and local end oscopic resection, since the malignancy of individual tumors differs w idely, We investigated the appropriateness of using endoscopic therapy for this disease, Patients and Methods: Twenty-two patients were diag nosed with rectal carcinoid tumors at the First Department of Internal Medicine, Yamaguchi University School of Medicine and its affiliated hospitals, from 1977 to 1994., The tumors were resected and examined r egarding their size, depth of invasion, and histological atypia, The p ost-treatment course in patients whose tumors were completely resected without atypia was observed by colonoscopy and ultrasonography at yea rly intervals. Results: In 21 patients, tumor invasion did not extend beyond the submucosal layer, and there were no signs of atypia, The si ze of the tumor varied from 2.2 mm to 10.0 mm in diameter, with an ave rage of 5.4 mm, After endoscopic resection of the tumors in 18 patient s and surgical local resection in three patients, no local recurrences or liver metastases were experienced, The patients survived for a min imum of 29 months and a maximum of 237 months; the mean survival perio d was 72.8 months, In one patient, the tumor showed cellular atypia in vading into the tunica muscularis, and measured 25 mm in diameter, The patient underwent surgery, but died ten months later due to liver met astasis, Conclusions: Endoscopic treatment of rectal carcinoid tumors was found to be appropriate when the tumor measured 10 mm or less in d iameter, did not infiltrate beyond the submucosal layer, and had no hi stological atypia.