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Diagnosis and Treatment of Rectal Neuroendocrine Tumor

직장 신경내분비종양의 진단과 치료

  • Shin, Hyun Deok (Department of Internal Medicine, Dankook University College of Medicine)
  • 신현덕 (단국대학교 의과대학 내과학교실)
  • Published : 2014.10.01

Abstract

Rectal neuroendocrine tumors (NETs) are not uncommon. Recently, the incidence of rectal NETs has increased markedly due to the widespread use of screening colonoscopy. Most rectal NETs detected incidentally are asymptomatic and at an early stage at diagnosis. Typical NETs < 10 mm in size and confined to the submucosal layer can be resected completely using various endoscopic treatments. These NETs have a good prognosis. However, not all NETs necessarily have good prognoses; those > 10 mm in size, with ulceration or depression, muscularis invasion seen on endoscopic ultrasonography (EUS), lymphovascular invasion, or a high mitotic index histologically are associated with metastasis. Generally, NETs < 10 mm can be treated endoscopically, while those > 20 mm should be resected surgically. The treatment of NETs between 10 and 20 mm is controversial. For these, it is necessary to choose an effective, safe primary resection method to ensure complete resection and to perform a careful histological examination of the resected tissue.

Keywords

References

  1. Langhans T. Ueber einen drusenpolyp im ileum. Virchows Arch Pathol Anat Physiol Klin Med 1876;38:559-560.
  2. Lubarsch O. Uber den primaren Krebs des ileum nebst Bemerkungen uber das gleichzeitige Vorkommen von Krebs and Tuberkulose. Virchows Arch 1888;3:280-317
  3. Oberndorfer S. Karzinoide Tumoren des Dunndarms. Frank Z Pathol 1907;1:426-429.
  4. Gosset A, Masson P. Tumeurs endocrines de l'appendice. Presse Med 1914;22:237-240.
  5. Solcia E, Kloppel G, Sobin LH, et al. Histologic Typing of Endocrine tumours. WHO International Histological Classification of Tumours. 2nd ed. Berlin: Springer, 2000.
  6. Ramage JK, Goretzki PE, Manfredi R, et al. Consensus guidelines for the management of patients with digestive neuroendocrine tumors: well-differentiated colon and rectum tumors/carcinoma. Neuroendocrinology 2008;87:31-39. https://doi.org/10.1159/000111036
  7. Niederle MB, Hackl M, Kaserer K, Niederle B. Gastroenteropancreatic neuroendocrine tumors: the current incidence and staging based on the WHO and European Neuroendocrine Tumor Society classification: an analysis based on prospectively collected parameters. Endocr Relat Cancer 2010;17:909-918. https://doi.org/10.1677/ERC-10-0152
  8. Anthony LB, Strosberg JR, Klimstra DS, et al. The NANETS consensus guidelines for the diagnosis and management of gastrointestinal neuroendocrine tumors (NETs): well-differentiated NETs of distal colon and rectum. Pancreas 2010;39:767-774. https://doi.org/10.1097/MPA.0b013e3181ec1261
  9. Bosman FT, Carneiro F, Hruban RH, Theise ND. WHO classification of tumours of the digestive system. 4th ed. Lyon: International Agency for Research on Cancer; 2010.
  10. Edge SB, Byrd DR, Compton CC. AJCC Cancer Staging Manual. 7th ed. New York: Springer; 2010.
  11. Yao JC, Hassan M, Phan A, et al. One hundred years after "Carcinoid": epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 2008;26:3063-3072. https://doi.org/10.1200/JCO.2007.15.4377
  12. Tsikitis VL, Wertheim BC, Guerrero MA. Trends of incidence and survival of gastrointestinal neuroendocrine tumors in the United States: a SEER analysis. J Cancer 2012;3:292-302. https://doi.org/10.7150/jca.4502
  13. de Mestier L, Brixi H, Gincul R, Ponchon T, Cadiot G. Updating the management of patients with rectal neuroendocrine tumors. Endoscopy 2013;45:1039-1046. https://doi.org/10.1055/s-0033-1344794
  14. Modlin IM, Kidd M, Lactich I, Zikusoka MN, Shapiro MD. Current status of gastrointestinal carcinoids. Gastroenterology 2005;128:1717-1751. https://doi.org/10.1053/j.gastro.2005.03.038
  15. Yao JC, Phan AT, Chang DZ, et al. Efficacy of RAD001 (everolimus) and octreotide LAR in advanced low- to intermediate-grade neuroendocrine tumors: results of a phase II study. J Clin Oncol 2008;1926:4311-4318.
  16. Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer 2003;97:934-959. https://doi.org/10.1002/cncr.11105
  17. Ito T, Sasano H, Tanaka M, et al. Epidemiological study of gastroenteropancreatic neuroendocrine tumors in Japan. J Gastroenterol 2010;45:234-243. https://doi.org/10.1007/s00535-009-0194-8
  18. Cho MY, Kim JM, Sohn JH, et al. Current trends of the incidence and pathological diagnosis of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) in Korea 2000-2009: multicenter study. Cancer Res Treat 2012;44:157-165. https://doi.org/10.4143/crt.2012.44.3.157
  19. Lee SP, Sung IK, Kim JH, Lee SY, Park HS, Shim CS. The effect of preceding biopsy on complete endoscopic resection in rectal carcinoid tumor. J Korean Med Sci 2014;29:512-518. https://doi.org/10.3346/jkms.2014.29.4.512
  20. Son HJ, Sohn DK, Hong CW, et al. Factors associated with complete local excision of small rectal carcinoid tumor. Int J Colorectal Dis 2013;28:57-61. https://doi.org/10.1007/s00384-012-1538-z
  21. Shim KN, Yang SK, Myung SJ, et al. Atypical endoscopic features of rectal carcinoids. Endoscopy 2004;36:313-316. https://doi.org/10.1055/s-2004-814202
  22. Kim BN, Sohn DK, Hong CW, et al. Atypical endoscopic features can be associated with metastasis in rectal carcinoids tumors. Surg Endosc 2008;22:1992-1996. https://doi.org/10.1007/s00464-008-0006-x
  23. Wang M, Peng J, Yang W, Chen W, Mo S, Cai S. Prognostic analysis for carcinoid tumors of the rectum: a single institutional analysis of 106 patients. Colorectal Dis 2011;13:150-153. https://doi.org/10.1111/j.1463-1318.2009.02090.x
  24. Ishii N, Horiki N, Itoh T, et al. Endoscopic submucosal dissection and preoperative assessment with endoscopic ultrasonography for the treatment of rectal carcinoid tumors. Surg Endosc 2010;24:1413-1419. https://doi.org/10.1007/s00464-009-0791-x
  25. Frilling A, Akerström G, Falconi M, et al. Neuroendocrine tumor disease: an evolving landscape. Endocr Relat Cancer 2012;19:R163-R185 https://doi.org/10.1530/ERC-12-0024
  26. Caplin M, Sundin A, Nillson O, et al. ENETS Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms: colorectal neuroendocrine neoplasms. Neuroendocrinology 2012;95:88-97. https://doi.org/10.1159/000335594
  27. Scherübl H, Jensen RT, Cadiot G, Stolzel U, Kloppel G. Management of early gastrointestinal neuroendocrine neoplasms. World J Gastrointest Endosc 2011;3:133-139. https://doi.org/10.4253/wjge.v3.i7.133
  28. Kobayashi K, Katsumata T, Yoshizawa S, et al. Indications of endoscopic polypectomy for rectal carcinoid tumors and clinical usefulness of endoscopic ultrasonography. Dis Colon Rectum 2005;48:285-291. https://doi.org/10.1007/s10350-004-0765-y
  29. Abe T, Kakemura T, Fujinuma S, Maetani I. Successful outcomes of EMR-L with 3D-EUS for rectal carcinoids compared with historical controls. World J Gastroenterol 2008;14:4054-4058. https://doi.org/10.3748/wjg.14.4054
  30. Park CH, Cheon JH, Kim JO, et al. Criteria for decision making after endoscopic resection of well-differentiated rectal carcinoids with regard to potential lymphatic spread. Endoscopy 2011;43:790-795. https://doi.org/10.1055/s-0030-1256414
  31. Weinstock B, Ward SC, Harpz N, Warner RR, Kim MK. Clinical and prognostic features of rectal neuroendocrine tumors. Neuroendocrinology 2013;98:180-187. https://doi.org/10.1159/000355612
  32. Rindi G. The ENETS guidelines: the new TNM classification system. Tumori 2010;96:806-809. https://doi.org/10.1177/030089161009600532
  33. Landry CS, Brock G, Scoggins CR, McMasters KM, Martin RC 2nd. A proposed staging system for rectal carcinoid tumors based on an analysis of 4701 patients. Surgery 2008;144:460-466. https://doi.org/10.1016/j.surg.2008.05.005
  34. Konishi T, Watanabe T, Kishimoto J, et al. Prognosis and risk factors of metastasis in colorectal carcinoids: results of a nationwide registry over 15 years. Gut 2007;56:863-868. https://doi.org/10.1136/gut.2006.109157
  35. Shields CJ, Tiret E, Winter DC. Carcinoid tumors of the rectum: a multi-institutional international collaboration. Ann Surg 2010;252:750-755. https://doi.org/10.1097/SLA.0b013e3181fb8df6
  36. Fahy BN, Tang LH, Klimstra D, et al. Carcinoid of the rectum risk stratification (CaRRs): a strategy for preoperative outcome assessment. Ann Surg Oncol 2007;14:1735-1743. https://doi.org/10.1245/s10434-006-9311-6
  37. Holinga J, Khalid A, Fasanella K, Sanders M, Davison J, McGrath K. Metastatic risk of diminutive rectal carcinoid tumors: a need for surveillance rectal ultrasound? Gastrointest Endosc 2012;75:913-916. https://doi.org/10.1016/j.gie.2011.11.032
  38. Fujimoto Y, Oya M, Kuroyanagi H, et al. Lymph-node metastases in rectal carcinoids. Langenbecks Arch Surg 2010;395:139-142. https://doi.org/10.1007/s00423-008-0438-8
  39. Konishi T, Watanabe T, Nagawa H, et al. Treatment of colorectal carcinoids: a new paradigm. World J Gastrointest Surg 2010;2:153-156. https://doi.org/10.4240/wjgs.v2.i5.153
  40. Kasuga A, Chino A, Uragami N, et al. Treatment strategy for rectal carcinoids: a clinicopathological analysis of 229 cases at a single cancer institution. J Gastroenterol Hepatol 2012; 27:1801-1807. https://doi.org/10.1111/j.1440-1746.2012.07218.x
  41. Maggard MA, O'Connell JB, Ko CY. Updated populationbased review of carcinoid tumors. Ann Surg 2004;240:117-122. https://doi.org/10.1097/01.sla.0000129342.67174.67
  42. Yoon SN, Yu CS, Shin US, Kim CW, Lim SB, Kim JC. Clinicopathological characteristics of rectal carcinoids. Int J Colorectal Dis 2010;25:1087-1092. https://doi.org/10.1007/s00384-010-0949-y
  43. Li AF, Hsu CY, Li A, et al. A 35-year retrospective study of carcinoid tumors in Taiwan: differences in distribution with a high probability of associated second primary malignancies. Cancer 2008;112:274-283. https://doi.org/10.1002/cncr.23159
  44. Soga J. Early-stage carcinoids of the gastrointestinal tract: an analysis of 1914 reported cases. Cancer 2005;103:1587-1595. https://doi.org/10.1002/cncr.20939
  45. Iishi H, Tatsuta M, Yano H, Narahara H, Iseki K, Ishiquro S. More effective endoscopic resection with a two-channel colonoscope for carcinoid tumors of the rectum. Dis Colon Rectum 1996;39:1438-1439. https://doi.org/10.1007/BF02054536
  46. Nagai T, Torishima R, Nakashima H, et al. Saline-assisted endoscopic resection of rectal carcinoids: cap aspiration method versus simple snare resection. Endoscopy 2004;36:202-205. https://doi.org/10.1055/s-2004-814248
  47. Zhao ZF, Zhang N, Ma SR, et al. A comparative study on endoscopy treatment in rectal carcinoid tumors. Surg Laparosc Endosc Percutan Tech 2012;22:260-263. https://doi.org/10.1097/SLE.0b013e3182512e0f
  48. Imada-Shirakata Y, Sakai M, Kajiyama T, et al. Endoscopic resection of rectal carcinoid tumors using aspiration lumpectomy. Endoscopy 1997;29:34-38. https://doi.org/10.1055/s-2007-1024058
  49. Oshitani N, Hamasaki N, Sawa Y, et al. Endoscopic resection of small rectal carcinoid tumors using an aspiration method with a transparent overcap. J Int Med Res 2000;28:241-246. https://doi.org/10.1177/147323000002800507
  50. Kim YJ, Lee SK, Cheon JH, et al. Efficacy of endoscopic resection for small rectal carcinoid: a retrospective study. Korean J Gastroenterol 2008;51:174-180.
  51. Koyama N, Yoshida H, Nihei M, Sakonji M, Wachi E. Endoscopic resection of rectal carcinoids using double snare polypectomy technique. Dig Endosc 1998;10:42-45. https://doi.org/10.1111/j.1443-1661.1998.tb00538.x
  52. Berkelhammer C, Jasper I, Kirvaitis E, Schreiber S, Hamilton J, Walloch J. "Band-snare" resection of small rectal carcinoid tumors. Gastrointest Endosc 1999;50:582-585. https://doi.org/10.1016/S0016-5107(99)70092-1
  53. Ono A, Fujii T, Saito Y, et al. Endoscopic submucosal resection of rectal carcinoid tumors with a ligation device. Gastrointest Endosc 2003;57:583-587. https://doi.org/10.1067/mge.2003.142
  54. Moon JH, Kim JH, Park CH, et al. Endoscopic submucosal resection with double ligation technique for treatment of small rectal carcinoid tumors. Endoscopy 2006;38:511-514. https://doi.org/10.1055/s-2006-925074
  55. Lee SH, Park SJ, Kim HH, et al. Endoscopic resection for rectal carcinoid tumors: comparison of polypectomy and endoscopic submucosal resection with band ligation. Clin Endosc 2012;45:89-94. https://doi.org/10.5946/ce.2012.45.1.89
  56. Kim HH, Park SJ, Lee SH, et al. Efficacy of endoscopic submucosal resection with a ligation device for removing small rectal carcinoid tumors compared with endoscopic mucosal resection: analysis of 100 cases. Dig Endosc 2012;24:159-163.
  57. Kim KM, Eo SJ, Shim SG, et al. Treatment outcomes according to endoscopic treatment modalities for rectal carcinoid tumors. Clin Res Hepatol Gastroenterol 2013;37:275-282. https://doi.org/10.1016/j.clinre.2012.07.007
  58. Onozato Y, Kakizaki S, Iizuka H, Sohara N, Mori M, Itoh H. Endoscopic treatment of rectal carcinoid tumors. Dis Colon Rectum 2010;53:169-176. https://doi.org/10.1007/DCR.0b013e3181b9db7b
  59. Niimi K, Goto O, Fujishiro M, et al. Endoscopic mucosal resection with a ligation device or endoscopic submucosal dissection for rectal carcinoid tumors: an analysis of 24 consecutive cases. Dig Endosc 2012;24:443-447. https://doi.org/10.1111/j.1443-1661.2012.01303.x
  60. Park HW, Byeon JS, Park YS, et al. Endoscopic submucosal dissection for treatment of rectal carcinoid tumors. Gastrointest Endosc 2010;72:143-149. https://doi.org/10.1016/j.gie.2010.01.040
  61. Lee DS, Jeon SW, Park SY, et al. The feasibility of endoscopic submucosal dissection for rectal carcinoid tumors: comparison with endoscopic mucosal resection. Endoscopy 2010;42:647-651. https://doi.org/10.1055/s-0030-1255591
  62. Suzuki S, Ishii N, Uemura M, et al. Endoscopic submucosal dissection (ESD) for gastrointestinal carcinoid tumors. Surg Endosc 2012;26:759-763. https://doi.org/10.1007/s00464-011-1948-y
  63. Saclarides TJ. TEM/local excision: indications, techniques, outcomes, and the future. J Surg Oncol 2007;96:644-650. https://doi.org/10.1002/jso.20922
  64. Tsai BM, Finne CO, Nordenstam JF, Christoforidis D, Madoff RD, Mellgren A. Transanal endoscopic microsurgery resection of rectal tumors: outcomes and recommendations. Dis Colon Rectum 2010;53:16-23. https://doi.org/10.1007/DCR.0b013e3181bbd6ee
  65. Kinoshita T, Kanehira E, Omura K, Tomori T, Yamada H. Transanal endoscopic microsurgery in the treatment of rectal carcinoid tumor. Surg Endosc 2007;21:970-974. https://doi.org/10.1007/s00464-006-9155-y
  66. Kumar AS, Sidani SM, Kolli K, et al. Transanal endoscopic microsurgery for rectal carcinoids: the largest reported United States experience. Colorectal Dis 2012;14:562-566. https://doi.org/10.1111/j.1463-1318.2011.02726.x
  67. Kwaan MR, Goldberg JE, Bleday R. Rectal carcinoid tumors: review of results after endoscopic and surgical therapy. Arch Surg 2008;143:471-475. https://doi.org/10.1001/archsurg.143.5.471
  68. Park CH, Chen JH, Kim JO, et al. Criteria for decision making after endoscopic resection of well-differentiated rectal carcinoids with regard to potential lymphatic spread. Endoscopy 2011;43:790-795. https://doi.org/10.1055/s-0030-1256414
  69. Bensoussan M, Lamarque D, Dousset B, Terris B, Brezault C, Chaussade S. What is the place of the endoscopic treatment in the endocrine tumors of the rectum? Gastroenterol Clin Biol 2008;32:985-988. https://doi.org/10.1016/j.gcb.2008.05.015
  70. Merg A, Wirtzfeld D, Wang J, Cheney R, Dunn KB, Raiput A. Viability of endoscopic and excisional treatment of early rectal carcinoids. J Gastrointest Surg 2007;11:893-897. https://doi.org/10.1007/s11605-007-0153-8
  71. Jeon SM, Lee JH, Hong SP, Kim TI, Kim WH, Chen JH. Feasibility of salvage endoscopic mucosal resection by using a cap for remnant rectal carcinoids after primary EMR. Gastrointest Endosc 2011;73:1009-1014. https://doi.org/10.1016/j.gie.2010.12.029

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