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TRANSANAL ENDOSCOPIC MICROSURGERY IN THE MANAGEMENT OF RECTAL CARCINOID.

Vasil Kyosev, Georgi Kotashev, Vencislav Mutafchiyski, Krasimir Vasilev, Plamen Ivanov, Grigor Grigorov, Vasilena Hristova, Dimitar Penchev

Abstract

AIMS: Carcinoid tumors, a type of neuro-endocrine tumors (NETs), comprise a heterogeneous group of neoplasms arising from cells of the neuro-endocrine system. Rectal carcinoid tumors are relatively uncommon, representing 1,1% to 1,3% of all rectal neoplasms. Their incidence is dramatically increasing. The aim of this study was to review our department`s experience and assess the efficacy of transanal endoscopic microsurgery (TEM) in the management of rectal carcinoid tumor.

METHODS: Between 2013 and 2015, four patients with rectal carcinoid underwent TEM, and their clinical data were reviewed retrospectively. 

RESULTS: Two patients (50%) were identified as high-risk patients and underwent TEM, full-thickness excision and two ones (50%) were identified as low-risk patients and underwent TEM, submucosal resection. One patient from the high-risk group was referred to us by gastroenterologist from another hospital for complete surgery after endoscopic polypectomy with microscopically tumor positive resection margin. Tumor size was bigger in high-risk patients than in low-risk ones (14 and 20 mm versus 7 and 9 mm). There was no lymphovascular invasion in both groups. The operation time was longer in the full-thickness excision than in the submucosal resection group (45 and 55 min versus 27 and 33 min). One patient with full-thickness excision was complicated with acute urinary retention. There was neither local recurrence, nor distant metastasis in our patients during the follow-up period. 

CONCLUSIONS: Our data suggest that TEM is a safe, minimally invasive approach for local excision of rectal carcinoid tumors and, generally, leads to good oncological and surgical outcomes. Furthermore, for patients with microscopically positive margins after endoscopic polypectomy, TEM can be an effective surgical option for complete residual tumor removal.


Keywords

rectal carcinoid, transanal endoscopic microsurgery, full-thickness excision, submucosal resection

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DOI: http://dx.doi.org/10.14748/ssm.v49i4.4022

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About The Authors

Vasil Kyosev
Military Medical Academy-Sofia, Bulgaria Clinic of endoscopic, endocrine surgery and coloproctology

Georgi Kotashev
Military Medical Academy-Sofia, Bulgaria Clinic of endoscopic, endocrine surgery and coloproctology

Vencislav Mutafchiyski
Military Medical Academy-Sofia, Bulgaria Clinic of endoscopic, endocrine surgery and coloproctology

Krasimir Vasilev
Military Medical Academy-Sofia, Bulgaria Clinic of endoscopic, endocrine surgery and coloproctology

Plamen Ivanov
Military Medical Academy-Sofia, Bulgaria Clinic of endoscopic, endocrine surgery and coloproctology

Grigor Grigorov
Military Medical Academy-Sofia, Bulgaria Clinic of endoscopic, endocrine surgery and coloproctology

Vasilena Hristova
Military Medical Academy-Sofia, Bulgaria Clinic of endoscopic, endocrine surgery and coloproctology

Dimitar Penchev
Military Medical Academy-Sofia, Bulgaria Clinic of endoscopic, endocrine surgery and coloproctology

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