Size Criteria Is Not Sufficient in Selecting Patients for Local Excision Versus Radical Excision for Rectal Neuroendocrine Tumors >2 cm: A National Cancer Database Analysis.

Background Patients with rectal neuroendocrine tumors >2 cm often undergo radical surgery, despite limited data supporting this practice. Five- and 10-year survival rates for these patients have been reported previously as 74.8% and 58.6%. Objective Overall survival was compared between local excision and radical surgery and pN0 and pN1 within the radical surgery subgroup for rectal neuroendocrine tumors >2 cm. Factors independently associated with survival were identified. Design A retrospective, nationwide, multivariate regression analysis was performed. Settings Data are from the National Cancer Database (2004-2013). Patients Patients with rectal neuroendocrine tumors >2 cm, excluding stages T4 and M1, were included. Main outcome measures Outcome measures were overall survival and independent risk factors for overall survival based on multivariate regression analysis. Results Each group had 178 patients. After local excision, 5- and 10-year overall survival rates were 88% and 72% vs 51% and 42% after radical surgery (p Limitations The study is a retrospective analysis and includes only Commission on Cancer-accredited hospitals. Long-term follow-up was limited. Lymphovascular invasion was missing for a majority of patients analyzed. Conclusions Local excision for select patients with rectal neuroendocrine tumors >2 cm is a viable alternative to radical surgery. Nodal status and tumor grade independently predict survival and should be factored into surgical intervention selection. In higher-risk patients selected for radical surgery, survival was similar between the pN0 and pN1 groups, possibly indicating a benefit of radical surgery for these patients. See Video Abstract at http://links.lww.com/DCR/B455. El criterio de tamao no es suficiente para seleccionar pacientes para la escisin local versus escisin radical para tumores neuroendocrinos rectales cm anlisis de una base de datos nacional de cancer ANTECEDENTES:Los pacientes con tumores neuroendocrinos rectales >2 cm a menudo se someten a cirugia radical, a pesar de los datos limitados que respaldan esta practica. La supervivencia a cinco y diez anos para estos pacientes se habia informado anteriormente como 74,8% y 58,6%, respectivamente.OBJETIVO:Se comparo la supervivencia global entre escision local y cirugia radical, y pN0 y pN1 dentro del subgrupo de cirugia radical para tumores neuroendocrinos rectales >2 cm. Se identificaron factores asociados de forma independiente con la supervivencia.DISENO:Se realizo un analisis retrospectivo de regresion multivariante a nivel nacional.AJUSTE:Los datos provienen de la Base de Datos Nacional sobre el cancer (2004-2013).PACIENTES:Pacientes con tumores neuroendocrinos rectales > 2 cm, excluyendo los estadios T4 y M1.PRINCIPALES MEDIDAS DE RESULTADO:Las medidas de resultado fueron la supervivencia general y los factores de riesgo independientes para la supervivencia general segun el analisis de regresion multivariante.RESULTADOS:Cada grupo tuvo 178 pacientes. Despues de la escision local, la supervivencia global a cinco y diez anos fue del 88% y 72% frente al 51% y el 42% despues de la cirugia radical (p 2 cm es una alternativa viable a la cirugia radical. El estado ganglionar y el grado del tumor predicen de forma independiente la supervivencia y deben tenerse en cuenta en la seleccion de la intervencion quirurgica. En los pacientes de mayor riesgo seleccionados para cirugia radical, la supervivencia fue similar entre los grupos pN0 vs. pN1, lo que posiblemente indica un beneficio de la cirugia radical para estos pacientes. Consulte Video Resumen en http://links.lww.com/DCR/B455.