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Local Excision Versus Radical Resection for 1- to 2-cm Neuroendocrine Tumors of the Rectum

A National Cancer Database Analysis

Fields, Adam C., M.D.1; Saadat, Lily V., M.D.1; Scully, Rebecca E., M.D., M.P.H.1; Davids, Jennifer S., M.D.2; Goldberg, Joel E., M.D., M.P.H.1; Bleday, Ronald, M.D.1; Melnitchouk, Nelya, M.D., M.Sc.1

Diseases of the Colon & Rectum: April 2019 - Volume 62 - Issue 4 - p 417–421
doi: 10.1097/DCR.0000000000001210
Original Contributions: Colorectal Cancer
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BACKGROUND: The optimal surgical management for 1- to 2-cm, nonmetastatic rectal neuroendocrine tumors remains unknown.

OBJECTIVE: We sought to determine overall survival and operative outcomes in patients who underwent local excision versus radical resection of rectal neuroendocrine tumors.

DESIGN: The National Cancer Database (2004–2013) was queried to identify patients with nonmetastatic rectal neuroendocrine tumors who underwent local excision or radical resection.

SETTING: The study included national data.

PATIENTS: There were 274 patients in the local excision group and 47 patients in the radical resection group.

MAIN OUTCOME MEASURES: The primary outcome was overall survival. Secondary outcomes included 30-day mortality, hospital length of stay, and procedural outcomes.

RESULTS: There were no differences in demographics between the 2 groups. Patients who underwent radical resection had slightly larger tumors with higher stage and grade. 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 d; p < 0.01). After adjusting with a Cox proportional hazards model, no difference was seen in survival between the 2 patient groups (HR = 2.39 (95% CI, 0.85–6.70); p = 0.10).

LIMITATIONS: There are several limitations, which include that this work is a retrospective review; the data set does not include variables such as depth of tumor invasion, which may influence surgical treatment or local recurrence rates; and patients were not randomly assigned to treatment groups.

CONCLUSIONS: There is no survival benefit to radical resection of 1- to 2-cm, nonmetastatic rectal neuroendocrine tumors. This suggests that local excision may be a feasible and less morbid option for intermediate-sized rectal neuroendocrine tumors. See Video Abstract at http://links.lww.com/DCR/A744.

1 Division of Colorectal Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts

2 University of Massachusetts Medical School, Worcester, Massachusetts

Funding/Support: None reported.

Financial Disclosure: None reported.

Presented at the meeting of the New England Surgical Society, Bretton Woods, NH, September 8 to 10, 2017. This study was given the Best Poster Award by the Society.

Correspondence: Nelya Melnitchouk, M.D., M.Sc., Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail: nmelnitchouk@bwh.harvard.edu and Adam C. Fields, M.D., Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail: acfields@partners.org

© 2019 The American Society of Colon and Rectal Surgeons