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Anorectal carcinoid tumors. Is aggressive surgery warranted?
P Sauven1, J A Ridge, S H Quan
1Colorectal Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Annals of Surgery
|January 1, 1990
Summary
Anorectal carcinoid tumors larger than 2 cm or at advanced stages are aggressive and often fatal. Early detection and complete local excision are crucial for successful treatment and cure of these rare rectal tumors.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Pathology
Background:
- Management of large anorectal carcinoid tumors remains controversial due to their rarity and advanced presentation.
- Most rectal and anal carcinoid tumors are early-stage and manageable with local excision.
- Advanced cases present diagnostic and therapeutic challenges for most institutions.
Purpose of the Study:
- To evaluate the clinical outcomes and survival rates of patients with anorectal carcinoid tumors.
- To identify prognostic factors influencing the management and prognosis of these tumors.
- To clarify the association between ulcerative colitis and rectal carcinoid tumors.
Main Methods:
- Retrospective analysis of 43 patients with anorectal carcinoid tumors treated between 1960 and 1988.
- Review of treatment modalities including local excision, radical surgery, and biopsy.
- Correlation of tumor size, stage, lymph node involvement, and patient survival.
Main Results:
- Median age of onset was 56 years; 19 patients were asymptomatic or incidentally diagnosed.
- Tumors >2 cm (n=20) were symptomatic and associated with poorer outcomes.
- Complete resection prevented local recurrence, but advanced tumors (T2+, >2 cm, or lymph node involvement) were largely fatal, with median survival of 10 months post-metastasis.
Conclusions:
- Advanced anorectal carcinoid tumors are aggressive malignancies.
- Early detection (before T3 stage, <2 cm, no lymph node involvement) is key for cure.
- Adequate local excision is effective for regional control, but radical surgery offers limited benefit if complete resection is achieved locally.
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