B. Ezekian1, M. A. Adam1, B. F. Gilmore1, Z. Sun1, M. L. Cox1, M. C. Turner1, C. R. Mantyh1, J. Migaly1 1Duke University Medical Center,Department Of Surgery,Durham, NC, USA
Introduction:
Current National Comprehensive Cancer Network (NCCN) guidelines recommend local resection for rectal carcinoids ≤2 cm and radical resection for tumors >2 cm. However, given the limited data examining the appropriate extent of surgery for these lesions, we queried a national database to determine the impact of extent of resection on pathologic lymph node positivity and survival.
Methods:
Patients undergoing surgical treatment for non-metastatic, clinically-node negative rectal carcinoid were identified from the National Cancer Data Base (1998-2012). The association between extent of surgery, tumor size, and the likelihood of lymph node positivity was examined. Kaplan-Meier analysis was used to compare overall survival between patients undergoing local vs. radical resection.
Results:
In total, 1,900 patients were identified, of whom 1,644 (86.5%) were treated with a local resection and 256 (13.5%) were treated with a radical resection. Patient age, race, co-morbidities, and 30-day mortality were not different between groups (all p > 0.05). A vast majority of patients with tumors ≤2 cm received a local excision (88.96%), whereas most patients with tumors 2.1-4 cm (55.17%) or >4 cm (54.17%) received radical surgery. In patients who underwent radical resection, those with larger tumor size were more likely to have lymph node metastases (7.0% of patients with ≤2 cm tumors, 31.3% with 2.1-4 cm tumors, and 50.0% with >4 cm tumors). 5-year survival was not different in patients receiving local vs. radical surgery for tumors <4 cm (93% vs 93%, p = 0.67 for tumors ≤2 cm and 76% vs. 76%, p = 0.77 for tumors 2.1-4 cm).
Conclusion:
In this large cohort of patients with rectal carcinoids, we show that while survival appears to be equivalent between local vs. radical resection for rectal carcinoids up to 4 cm, the likelihood of lymph node metastases significantly increases with tumor size >2 cm. Thereby, current guidelines recommending radical resection for tumors >2 cm seem appropriate.