Rectal Carcinoid Tumor: Treatment and Long-Term Outcome in 30 Cases

直腸類癌：治療經驗與長期預後在30個病人

黃允中(Yung-Jung Huang) ； 王瑞和(Jui-Ho Wang) ； 金台明(Tai-Ming King) ； 王心泰(Hsin-Tai Wang)

《中華民國大腸直腸外科醫學會雜誌》 22卷3期 (2011/09) Pp. 72-78

https://doi.org/10.6312/SCRSTW.2011.22(3).10008

摘要

目的　直腸類癌很少見；如何對這些病人提供最好的治療仍然不是很清楚。本篇研究的目的是對於30個直腸類癌病人提供我們的治療經驗與這些病人的長期預後，並且與其他臨床研究做比較。根據我們的治療經驗，具體提出關於治療直腸類癌的建議。病人與方法　此篇是回溯性的研究文章，收集高雄榮民總醫院從1991年到2010年，共3034例大腸直腸惡性腫瘤，其中有30例是直腸類癌。25個病人接受單通道內視鏡息肉切除術，而其他5位病人接受根治性手術。最後，對於腫瘤的完整切除率，與內視鏡切除術相關的併發症，局部復發率和遠處轉移率進行評估。結果　一共有30個病人被診斷為直腸類癌。其中有21個男性和9名女性，平均年齡為54.0 ± 13.7歲。經由內視鏡切除的腫瘤大小介於2至15毫米，平均大小為6.6 ± 2.8毫米；而且沒有非典型內視鏡特徵。經由內視鏡切除的完整切除率是44%。並沒有發生與內視鏡切除術相關的併發症，如穿孔或出血。接受內視鏡切除術的25個病人在平均追蹤36個月後並沒有發現局部復發或遠處轉移。即使是接受根治性手術的5個病人，在至少追蹤22個月後也沒有發現局部復發或遠處轉移。結論　直腸類癌很少發生遠處轉移時，當他們：（1）大小小於10毫米，（2）沒有非典型內視鏡特徵，（3）侵犯深度僅限於黏膜下層，（4）沒有淋巴及血管侵犯。直腸類癌如符合上述四點特徵則適合經內視鏡局部切除術。

關鍵字

直腸類癌 ； 長期預後 ； 息肉切除術

並列摘要

Purpose. Rectal carcinoid tumors are rare; the best treatment of patients with such tumors remains uncertain. This study describes our treatment of 30 patients with rectal carcinoid tumors, evaluates their long-term outcomes, and discusses our findings vis-a-vis similar clinical studies. We suggest specific recommendations regarding the treatment of rectal carcinoid tumors.Patients and Methods. Data were obtained retrospectively from a database of all colorectal malignancies at Kaohsiung Veterans General Hospital. From 1991 to 2010, 3,034 colorectal malignant tumors and 30 rectal carcinoid tumors were diagnosed. One-channel endoscopic polypectomy was performed on 25 patients, while the other 5 underwent radical surgery. We evaluated the rates of complete resection, complications associated with the procedure, local recurrence, and distant metastasis.Results. Thirty patients (21 men and 9 women; mean age, 54.0 ± 13.7 years) were diagnosed with rectal carcinoid tumor. Tumors removed by polypectomy measured 2-15 mm (mean size, 6.6 ± 2.8 mm). No atypical endoscopic features were associated with these tumors. The rate of complete resection was 44%. Complications from the procedure, such as perforation or bleeding, were not found. Neither local recurrence nor distant metastasis was detected during follow-up examinations for an average of 36 months after polypectomy. The five patients who underwent radical surgery, local recurrence or distant metastasis was not detected during follow-up examinations at least 22 months after surgery.Conclusion. Rectal carcinoid tumors rarely metastasize when they: (1) are less than 10 mm in diameter, (2) exhibit no atypical endoscopic features, (3) are confined to the submucosal layer, and (4) are not associated with lymphovascular invasion. Tumors that fit this profile are suitable for local excision by endoscopic resection.

並列關鍵字

Rectal carcinoid tumor ； Long-term outcome ； Polypectomy