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Local excision results in comparable survival to radical resection for early-stage rectal carcinoid.

Publication ,  Journal Article
Ezekian, B; Adam, MA; Turner, MC; Gilmore, BF; Freischlag, K; Leraas, HJ; Mantyh, CR; Migaly, J
Published in: J Surg Res
October 2018

BACKGROUND: Controversy exists regarding current National Comprehensive Cancer Network guidelines, which recommend local excision for rectal carcinoids ≤2 cm and radical resection for tumors >2 cm. Given the limited data examining optimal surgical approach for these lesions, we queried a national database to determine the impact of extent of resection on survival. METHODS: Patients undergoing treatment for clinical stage I and II rectal carcinoid (RC) were identified from the National Cancer Data Base (1998-2012). The association between extent of surgery, tumor size, and the likelihood of pathologic lymph node positivity was examined. Kaplan-Meier analysis was used to compare overall survival. RESULTS: In total, 1900 patients were identified, of whom 1644 (86.5%) were treated with local excision, and 256 (13.5%) were treated with radical resection. A significant majority of patients with tumors ≤2.0 cm (89.0%) and nearly half with tumors 2.1-4.0 cm (44.8%) or >4.0 cm (45.8%) underwent local excision. Nodal positivity was correlated with tumor size (7.1% positivity with ≤2.0 cm tumors, 31.3% with 2.1-4.0 cm tumors, and 50.0% with >4 cm tumors). However, 5-y survival was equivalent between surgical approaches for tumors ≤2 cm (93.0% versus 93.0%) and tumors 2.1-4.0 cm (76.0% versus 76.0%). CONCLUSIONS: We demonstrate in early-stage RC that nearly half of intermediate and large tumors are being treated with local excision outside National Comprehensive Cancer Network guidelines. In addition, radical resection does not appear to be associated with improved overall survival for tumors of any size. These findings suggest that the preferred approach to early-stage RCs without aggressive biological characteristics is local excision due to the decreased morbidity and mortality versus radical resection.

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Published In

J Surg Res

DOI

EISSN

1095-8673

Publication Date

October 2018

Volume

230

Start / End Page

28 / 33

Location

United States

Related Subject Headings

  • Tumor Burden
  • Survival Rate
  • Surgery
  • Retrospective Studies
  • Rectal Neoplasms
  • Proctectomy
  • Practice Guidelines as Topic
  • Neoplasm Staging
  • Middle Aged
  • Margins of Excision
 

Citation

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Ezekian, B., Adam, M. A., Turner, M. C., Gilmore, B. F., Freischlag, K., Leraas, H. J., … Migaly, J. (2018). Local excision results in comparable survival to radical resection for early-stage rectal carcinoid. J Surg Res, 230, 28–33. https://doi.org/10.1016/j.jss.2018.04.038
Ezekian, Brian, Mohamad A. Adam, Megan C. Turner, Brian F. Gilmore, Kyle Freischlag, Harold J. Leraas, Christopher R. Mantyh, and John Migaly. “Local excision results in comparable survival to radical resection for early-stage rectal carcinoid.J Surg Res 230 (October 2018): 28–33. https://doi.org/10.1016/j.jss.2018.04.038.
Ezekian B, Adam MA, Turner MC, Gilmore BF, Freischlag K, Leraas HJ, et al. Local excision results in comparable survival to radical resection for early-stage rectal carcinoid. J Surg Res. 2018 Oct;230:28–33.
Ezekian, Brian, et al. “Local excision results in comparable survival to radical resection for early-stage rectal carcinoid.J Surg Res, vol. 230, Oct. 2018, pp. 28–33. Pubmed, doi:10.1016/j.jss.2018.04.038.
Ezekian B, Adam MA, Turner MC, Gilmore BF, Freischlag K, Leraas HJ, Mantyh CR, Migaly J. Local excision results in comparable survival to radical resection for early-stage rectal carcinoid. J Surg Res. 2018 Oct;230:28–33.
Journal cover image

Published In

J Surg Res

DOI

EISSN

1095-8673

Publication Date

October 2018

Volume

230

Start / End Page

28 / 33

Location

United States

Related Subject Headings

  • Tumor Burden
  • Survival Rate
  • Surgery
  • Retrospective Studies
  • Rectal Neoplasms
  • Proctectomy
  • Practice Guidelines as Topic
  • Neoplasm Staging
  • Middle Aged
  • Margins of Excision