A Retrospecitve Study on the Strategy for Rectal Carcinoid with a Diameter of 15 mm or Less

Noritsugu Kuranaga, Hidetaka Mochizuki, Kazutsugu Iamoto, Shoetsu Tamakuma, Kazuo Hase*, Chiyuki Watanabe*

First Department of Surgery, National Defense Medical College
*Department of Surgery, Self-Defense Forces Central Hospital

Twenty-four lesions of rectal carcinoids with a diameter of 15 mm or less were retrospectively clinically analyzed. Invasion was limited to the submucosal layer (sm) in 21 lesions, and spread to the proper muscle layer (mp) in the other 3 lesions. For sm lesions, endoscopic polypectomy was performed first in 12 lesions followed by trans-anal local resection (TAR) in 7 of them because of a positive tumor cut end {ce (+) }. TAR was performed first in 8 cases and low anterior resection (LAR) in another case. All surgically resected specimens showed ce (-). For mp lesions, no operation was performed on one patient with multiple liver metastases. Miles' operation was performed on another one, and another, who was found to have lymph node metastasis received LAR. Two (25%) of 8 patients with lesions more than 10 mm in diameter had metastases and 3 (37.5%) had mp invasion. It was suggested that local resection is indicated for carcinoid tumors with a diameter of 10 mm or less. For tumors with a diamteter of 11 mm or more, radical resection is indicated first for those with mp invasion or deeper, whereas local resection is recommended for those with sm invasion. Trans-anal local resection is the most proper procedure for loca1 resection.

Key words
rectal carcinoid, trans-anal local resection, depth of invasion

Reprint requests
Noritsugu Kuranaga First Department of Surgery, National Defense Medical College
3-2 Namiki, Tokorozawa, 359 JAPAN

Accepted
October 9, 1996

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