Endoscopic submucosal dissection for rectal neuroendocrine (carcinoid) tumors

Rectal neuroendocrine (carcinoid) tumors smaller than 1 cm without lymph node metastasis and confined within the submucosal layer (stage T1aN0) can be treated using endoscopic resection. The present study was aimed to assess the safety and efficacy of endoscopic submucosal dissection (ESD) for T1aN0 carcinoid tumors.

A total of 35 consecutive patients with a T1aN0 rectal carcinoid tumor were enrolled between March 2007 and December 2009. The study evaluated the histologically complete resection rate, procedure time, complications, and short-term oncological outcomes.

The mean patient age was 49.0 years (range, 32-74 years), and there were 25 men and 10 women. The mean procedure time was 35.6 minutes (range, 7-82 minutes). All neoplasms were removed in one piece, and the histologically complete resection rate was 74.3% (26 cases including 5 cases showing no residual tumor). No post-ESD bleeding was observed. Abdominal computed tomography scans showed a perforation in 1 patient only, but that perforation was not associated with any peritonitis symptoms, and the patient was discharged on postprocedure day 3. One patient underwent radical surgery after ESD because of angiolymphatic invasion and positive resection margins, and the final pathology revealed no residual tumor or lymph node metastasis. No patient showed local recurrence or distant metastasis during a median follow-up of 25 months (range, 12-43 months).

ESD is feasible and safe for treating T1aN0 rectal carcinoid tumors. Further studies are required to accurately determine long-term oncological outcomes.