Surgical management of rectal carcinoids: trends and outcomes from the Surveillance, Epidemiology, and End Results database (1988 to 2012)

• Published in: The American journal of surgery Vol. 211; no. 5; pp. 877 - 885
• Main Author: McConnell, Yarrow J., M.D., M.Sc., F.R.C.S.C
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2016; Elsevier Limited
• Subjects: Adult; Age; Aged; Analysis of Variance; British Columbia; Cancer; Carcinoid; Carcinoid Tumor - mortality; Carcinoid Tumor - pathology; Carcinoid Tumor - surgery; Chi-Square Distribution; Colectomy - adverse effects; Colectomy - methods; Confidence intervals; Databases, Factual; Disease; Disease-Free Survival; Epidemiology; Female; Humans; Intestinal Neoplasms - mortality; Intestinal Neoplasms - pathology; Intestinal Neoplasms - surgery; Kaplan-Meier Estimate; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic system; Male; Middle Aged; Multivariate Analysis; Neoplasm Invasiveness - pathology; Neoplasm Staging; Neuroendocrine tumor; Outcomes; Prognosis; Rectal Neoplasms - mortality; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Rectum; Retrospective Studies; SEER Program; Surgery; Surveillance; Survival Analysis; Transanal excision; Treatment Outcome; Trends; Tumors; Transanal excision; Carcinoid; Neuroendocrine tumor; Epidemiology; Outcomes; Rectum
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2016.01.008

Abstract Background Local excision of small (<10 mm) rectal carcinoids is a standard treatment. Actual patterns of care and outcomes are understudied because of the rarity of this tumor. Methods Surveillance, Epidemiology, and End Results database (1988 to 2012) was interrogated for rectal carcinoid patients. Chi-square testing and Kaplan-Meier survival analysis were used to compare survival outcomes. Results Of all, 11,329 patients were identified—9,605 with only localized disease. The majority (77%) underwent local excision only. Full rectal resection was performed more frequently for tumors greater than 10 mm (11.7% to 12.2%) than for tumors less than 10 mm (4.5% to 4.9%, P < .001), and for higher T stage (T1: 4.0%, T2: 11.4%, T3/4:30.4%, P < .001). Nonoperative management was more common after year 2000 (11.2% to 13.7%) than prior (7.4% to 8.5%, P < .001). Cancer-specific survival improved across time periods but did not differ between nonoperative, local excision, or surgical resection. Conclusions Nonexcisional management of small, localized rectal carcinoids is becoming more common and may offer equivalent survival to excision or resection.