Colonoscopy in a 52-year-old man identifies a 0.8 cm submucosal nodule in the upper rectum. Biopsy shows a well-differentiated neuroendocrine tumour. Endoscopic ultrasound confirms no invasion of the muscularis propria and no regional lymphadenopathy. What is the appropriate management?
- A Abdominoperineal resection
- B Total mesorectal excision via low anterior resection
- C Endoscopic mucosal resection with surveillance ✓
- D Octreotide therapy with six-monthly octreotide scans
Correct answer: C. Endoscopic mucosal resection with surveillance
Explanation
Rectal neuroendocrine tumours under 1 cm in size without muscularis propria invasion carry a very low metastatic potential and are adequately treated by endoscopic or transanal local excision with follow-up. Size of 2 cm or greater, or invasion of the muscularis propria, shifts management toward formal oncological resection such as anterior resection or abdominoperineal excision. Octreotide is palliative therapy for metastatic functioning disease and plays no role here.
Reference: Schwartz's Principles of Surgery, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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