Criteria for decision making after endoscopic resection of well-differentiated rectal carcinoids with regard to potential lymphatic spread

C. H. Park, JaeHee Cheon, J. O. Kim, J. E. Shin, B. I. Jang, S. J. Shin, Y. T. Jeen, S. H. Lee, J. S. Ji, D. S. Han, S. A. Jung, D. I. Park, I. H. Baek, S. H. Kim, D. K. Chang

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Abstract

Background and study aim: Rectal carcinoids are low-grade malignancies that are usually treated by endoscopic resection. However, on pathologic examination, resection margins that are positive for carcinoid cells are frequently found. Patient outcomes were reviewed after endoscopic resection of rectal carcinoids and the clinical significance of possible residual disease, as defined by pathologic and endoscopic examination, was evaluated. Patients and methods: The medical records and endoscopic findings of 347 patients presenting with rectal carcinoids to 14 university hospitals in Korea between January 1999 and June 2007 were retrospectively analyzed. Results: A total of 304 patients were treated with endoscopic resection, and 43 patents were treated with surgery. In the endoscopic resection group, the complete resection rate was 88.2% based on endoscopic appearance (CR-E) and 60.2% based on pathologic evaluation (CR-P). The agreement between CR-E and CR-P was low (=0.192). No residual tumors were found in 77 of 85 patients (90.6%) who were CR-E but not CR-P and who had endoscopic biopsy taken at 24-month follow-up. The receiver-operating characteristic curve identified an optimal cut-off value of 10.5mm, at which the sensitivity and the specificity for metastasis were 100% and 89%, respectively. The risk factors for metastasis by multivariate analysis were tumor size, increased mitotic rate, and lymphovascular invasion. Conclusions: Endoscopic resection is a safe and effective modality for treating well-differentiated rectal carcinoids smaller than 10mm in diameter. Discrepancies were observed between CR-E and CR-P. The risk factors for metastasis were tumor size, increased mitotic rate, and lymphovascular invasion.

Original languageEnglish
Pages (from-to)790-795
Number of pages6
JournalEndoscopy
Volume43
Issue number9
DOIs
Publication statusPublished - 2011 Jul 8

Fingerprint

Carcinoid Tumor
Decision Making
Neoplasm Metastasis
Neoplasms
Patents
Residual Neoplasm
Korea
ROC Curve
Medical Records
Multivariate Analysis
Biopsy
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Park, C. H. ; Cheon, JaeHee ; Kim, J. O. ; Shin, J. E. ; Jang, B. I. ; Shin, S. J. ; Jeen, Y. T. ; Lee, S. H. ; Ji, J. S. ; Han, D. S. ; Jung, S. A. ; Park, D. I. ; Baek, I. H. ; Kim, S. H. ; Chang, D. K. / Criteria for decision making after endoscopic resection of well-differentiated rectal carcinoids with regard to potential lymphatic spread. In: Endoscopy. 2011 ; Vol. 43, No. 9. pp. 790-795.
@article{0e1e6c253f1b47199fe7d1193c955762,
title = "Criteria for decision making after endoscopic resection of well-differentiated rectal carcinoids with regard to potential lymphatic spread",
abstract = "Background and study aim: Rectal carcinoids are low-grade malignancies that are usually treated by endoscopic resection. However, on pathologic examination, resection margins that are positive for carcinoid cells are frequently found. Patient outcomes were reviewed after endoscopic resection of rectal carcinoids and the clinical significance of possible residual disease, as defined by pathologic and endoscopic examination, was evaluated. Patients and methods: The medical records and endoscopic findings of 347 patients presenting with rectal carcinoids to 14 university hospitals in Korea between January 1999 and June 2007 were retrospectively analyzed. Results: A total of 304 patients were treated with endoscopic resection, and 43 patents were treated with surgery. In the endoscopic resection group, the complete resection rate was 88.2{\%} based on endoscopic appearance (CR-E) and 60.2{\%} based on pathologic evaluation (CR-P). The agreement between CR-E and CR-P was low (=0.192). No residual tumors were found in 77 of 85 patients (90.6{\%}) who were CR-E but not CR-P and who had endoscopic biopsy taken at 24-month follow-up. The receiver-operating characteristic curve identified an optimal cut-off value of 10.5mm, at which the sensitivity and the specificity for metastasis were 100{\%} and 89{\%}, respectively. The risk factors for metastasis by multivariate analysis were tumor size, increased mitotic rate, and lymphovascular invasion. Conclusions: Endoscopic resection is a safe and effective modality for treating well-differentiated rectal carcinoids smaller than 10mm in diameter. Discrepancies were observed between CR-E and CR-P. The risk factors for metastasis were tumor size, increased mitotic rate, and lymphovascular invasion.",
author = "Park, {C. H.} and JaeHee Cheon and Kim, {J. O.} and Shin, {J. E.} and Jang, {B. I.} and Shin, {S. J.} and Jeen, {Y. T.} and Lee, {S. H.} and Ji, {J. S.} and Han, {D. S.} and Jung, {S. A.} and Park, {D. I.} and Baek, {I. H.} and Kim, {S. H.} and Chang, {D. K.}",
year = "2011",
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Park, CH, Cheon, J, Kim, JO, Shin, JE, Jang, BI, Shin, SJ, Jeen, YT, Lee, SH, Ji, JS, Han, DS, Jung, SA, Park, DI, Baek, IH, Kim, SH & Chang, DK 2011, 'Criteria for decision making after endoscopic resection of well-differentiated rectal carcinoids with regard to potential lymphatic spread', Endoscopy, vol. 43, no. 9, pp. 790-795. https://doi.org/10.1055/s-0030-1256414

Criteria for decision making after endoscopic resection of well-differentiated rectal carcinoids with regard to potential lymphatic spread. / Park, C. H.; Cheon, JaeHee; Kim, J. O.; Shin, J. E.; Jang, B. I.; Shin, S. J.; Jeen, Y. T.; Lee, S. H.; Ji, J. S.; Han, D. S.; Jung, S. A.; Park, D. I.; Baek, I. H.; Kim, S. H.; Chang, D. K.

In: Endoscopy, Vol. 43, No. 9, 08.07.2011, p. 790-795.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Criteria for decision making after endoscopic resection of well-differentiated rectal carcinoids with regard to potential lymphatic spread

AU - Park, C. H.

AU - Cheon, JaeHee

AU - Kim, J. O.

AU - Shin, J. E.

AU - Jang, B. I.

AU - Shin, S. J.

AU - Jeen, Y. T.

AU - Lee, S. H.

AU - Ji, J. S.

AU - Han, D. S.

AU - Jung, S. A.

AU - Park, D. I.

AU - Baek, I. H.

AU - Kim, S. H.

AU - Chang, D. K.

PY - 2011/7/8

Y1 - 2011/7/8

N2 - Background and study aim: Rectal carcinoids are low-grade malignancies that are usually treated by endoscopic resection. However, on pathologic examination, resection margins that are positive for carcinoid cells are frequently found. Patient outcomes were reviewed after endoscopic resection of rectal carcinoids and the clinical significance of possible residual disease, as defined by pathologic and endoscopic examination, was evaluated. Patients and methods: The medical records and endoscopic findings of 347 patients presenting with rectal carcinoids to 14 university hospitals in Korea between January 1999 and June 2007 were retrospectively analyzed. Results: A total of 304 patients were treated with endoscopic resection, and 43 patents were treated with surgery. In the endoscopic resection group, the complete resection rate was 88.2% based on endoscopic appearance (CR-E) and 60.2% based on pathologic evaluation (CR-P). The agreement between CR-E and CR-P was low (=0.192). No residual tumors were found in 77 of 85 patients (90.6%) who were CR-E but not CR-P and who had endoscopic biopsy taken at 24-month follow-up. The receiver-operating characteristic curve identified an optimal cut-off value of 10.5mm, at which the sensitivity and the specificity for metastasis were 100% and 89%, respectively. The risk factors for metastasis by multivariate analysis were tumor size, increased mitotic rate, and lymphovascular invasion. Conclusions: Endoscopic resection is a safe and effective modality for treating well-differentiated rectal carcinoids smaller than 10mm in diameter. Discrepancies were observed between CR-E and CR-P. The risk factors for metastasis were tumor size, increased mitotic rate, and lymphovascular invasion.

AB - Background and study aim: Rectal carcinoids are low-grade malignancies that are usually treated by endoscopic resection. However, on pathologic examination, resection margins that are positive for carcinoid cells are frequently found. Patient outcomes were reviewed after endoscopic resection of rectal carcinoids and the clinical significance of possible residual disease, as defined by pathologic and endoscopic examination, was evaluated. Patients and methods: The medical records and endoscopic findings of 347 patients presenting with rectal carcinoids to 14 university hospitals in Korea between January 1999 and June 2007 were retrospectively analyzed. Results: A total of 304 patients were treated with endoscopic resection, and 43 patents were treated with surgery. In the endoscopic resection group, the complete resection rate was 88.2% based on endoscopic appearance (CR-E) and 60.2% based on pathologic evaluation (CR-P). The agreement between CR-E and CR-P was low (=0.192). No residual tumors were found in 77 of 85 patients (90.6%) who were CR-E but not CR-P and who had endoscopic biopsy taken at 24-month follow-up. The receiver-operating characteristic curve identified an optimal cut-off value of 10.5mm, at which the sensitivity and the specificity for metastasis were 100% and 89%, respectively. The risk factors for metastasis by multivariate analysis were tumor size, increased mitotic rate, and lymphovascular invasion. Conclusions: Endoscopic resection is a safe and effective modality for treating well-differentiated rectal carcinoids smaller than 10mm in diameter. Discrepancies were observed between CR-E and CR-P. The risk factors for metastasis were tumor size, increased mitotic rate, and lymphovascular invasion.

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DO - 10.1055/s-0030-1256414

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SP - 790

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JO - Endoscopy

JF - Endoscopy

SN - 0013-726X

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