Local Excision Versus Radical Resection for 1 to 2cm Carcinoid Tumors of the Rectum: A National Cancer Database Analysis
*Adam C Fields, *Rebecca E Scully, *Lily Saadat, *Joel E Goldberg, Ronald Bleday, *Nelya Melnitchouk
Brigham and Women's Hospital, Boston, MA
Objective: The optimal surgical management for 1 to 2cm, nonmetastatic rectal carcinoid tumors remains unknown. Our goal is to investigate overall survival and operative outcomes in patients who underwent local excision versus radical resection of rectal carcinoid tumors. Design: Retrospective review of national database. Setting: National data. Patients: The National Cancer Database (2004-2013) was used to identify patients with nonmetastatic rectal carcinoid tumors who underwent local excision (i.e. excision, polypectomy) or radical resection (i.e. low anterior resection, abdominoperineal resection). There were 274 patients in the local excision group and 47 patients in the radical resection group. Main Outcome Measures: The primary outcome is overall survival. Chi-square and Wilcoxon rank-sum tests were carried out for bivariate analysis and a Cox Proportional-hazards model was used to determine predictors of survival. Results: There were no differences in demographics between the two groups. Patients who underwent radical resection had higher stage, grade, and size of tumor. Patients undergoing local excision had higher rates of positive margins (8.23% vs. 0%, p=0.04). There were no deaths within 30 days in either group but patients who had radical resection had longer median hospital length of stay (0 vs. 3 days, p < 0.01) After adjusting with cox proportional hazards modeling, no difference was seen in survival between the two patient groups (HR:2.39, 95%CI:0.85-6.70, p=0.10; Table1). Conclusions: There is no survival benefit to radical resection of 1 to 2cm, nonmetastatic rectal carcinoid tumors. This suggests that local excision may be a feasible option for small rectal carcinoid tumors.
|Predictor||Hazard Ratio||95% Confidence Interval||P Value|
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