Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2015; 21(7): 2220-2224
Published online Feb 21, 2015. doi: 10.3748/wjg.v21.i7.2220
Resection of multiple rectal carcinoids with transanal endoscopic microsurgery: Case report
Jiao-Lin Zhou, Guo-Le Lin, Da-Chun Zhao, Guang-Xi Zhong, Hui-Zhong Qiu
Jiao-Lin Zhou, Guo-Le Lin, Hui-Zhong Qiu, Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
Da-Chun Zhao, Department of Pathology, Peking Union Medical College Hospital, Beijing 100730, China
Guang-Xi Zhong, Department of Ultrasound, Peking Union Medical College Hospital, Beijing 100730, China
Author contributions: Lin GL and Qiu HZ designed the research; Lin GL, Zhou JL, Zhao DC, Zhong GX and Qiu HZ performed the research; Zhou JL analyzed the data and wrote the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Guo-Le Lin, MD, Department of General Surgery, Peking Union Medical College Hospital, Shuaifuyuan Rd 1, Beijing 100730, China. linguole@126.com
Telephone: +86-10-69152210 Fax: +86-10-69152211
Received: June 30, 2014
Peer-review started: July 1, 2014
First decision: July 21, 2014
Revised: September 26, 2014
Accepted: November 30, 2014
Article in press: December 1, 2014
Published online: February 21, 2015
Abstract

Multiple rectal carcinoids are rare. Due to the unreliability of endoscopic polypectomy in treating these submucosal lesions, a laparotomy is usually performed. We present a case report on multiple rectal carcinoids with three carcinoid foci < 10 mm in diameter located in the mid-rectum. Preoperative examination showed the lesions to be confined to the submucosal layer with no perirectal nodal involvement. A transanal endoscopic microsurgery was successfully performed to remove the three lesions with accurate full-thickness resection followed by secured suture closure. The postoperative pathology revealed neuroendocrine tumors G1 (carcinoids) located within the submucosal layer without lymphatic or vessel infiltration. Both the deep and lateral surgical margins were completely free of tumor cells. The patient recovered quickly and uneventfully. No tumor recurrence was observed at the six-month follow-up. For the multiple small rectal carcinoids without muscularis propria or lymphatic invasion, transanal endoscopic microsurgery offers a reliable and efficient alternative approach to traditional laparotomy for select patients, with the added advantages of minimally invasive surgery.

Keywords: Colorectal, Gastrointestinal surgery, Oncological surgery, Technical, Minimally invasive surgery

Core tip: A rare case of multiple small rectal carcinoids being successfully removed using the transanal endoscopic microsurgery technique. On the basis of careful preoperative evaluation and detailed postoperative pathological examination, transanal endoscopic microsurgery offers a safe, reliable and efficient alternative approach to the traditional surgeries for select patients with multiple rectal carcinoids.