Local therapy of small rectal carcinoids (<2 cm) is a matter of debate. The excellent article by Kwaan et al,1 recently published in the Archives, highlights this important issue.
Rectal carcinoids smaller than 2 cm have been and are being managed differently in different parts of the world.1- 9 Owing to a lack of controlled prospective studies, our current management of rectal carcinoids is flawed by a low level of evidence. The best we can do for the time being is to base guidelines and recommendations on all the available (retrospective) data from case series, large hospital registries, and national tumor registries. Of course, the individual patient's situation has to be considered too. A 20-mm, well-differentiated rectal carcinoid may well be managed differently in a fit, otherwise healthy 32-year-old woman than in an 85-year-old multimorbid patient.
Scherübl H. Local Therapy of Rectal Carcinoids: A Matter of Debate. Arch Surg. 2009;144(2):193-197. doi:10.1001/archsurg.2008.542