Clinical significance of immunohistochemical lymphovascular evaluation to determine additional surgery after endoscopic submucosal dissection for colorectal T1 carcinoma

Nishimura, T; Oka, Shiro; Tanaka, Shinji; Asayama, Naoki; Nagata, Shinji; Tamaru, Yuzuru; Kuwai, Toshio; Yamashita, Ken; Kitadai, Yasuhiko; Arihiro, Koji; Kuraoka, Kazuya; Kaneko, Mayumi; Shimamoto, Fumio; Chayama, Kazuaki

doi:10.1007/s00384-020-03795-5

Cited by 17 publications

(13 citation statements)

References 36 publications

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“…A smaller series found lymphatic permeation as the only independent risk factor for the presence of LNM [21]. In fact, this was reproduced in other studies, and it was clearly verified in our cohort [22]. For LNM, little is known about the individual relevance of the other high-risk factors in HRRs.…”

Section: Discussionsupporting

confidence: 89%

Risk of residual neoplasia after a noncurative colorectal endoscopic submucosal dissection for malignant lesions: a multinational study

et al. 2022

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Background and study aims: Endoscopic submucosal dissection (ESD) in colorectal lesions is technically demanding, and a significant rate of non-curative procedures is expected. We aimed to assess the rate of residual lesion after a non-curative ESD for colorectal cancer (CRC), and to establish predictive scores to be applied in the clinical setting. Patients and Methods: Retrospective multicenter analysis of consecutive colorectal ESDs. Patients with non-curative ESDs performed for the treatment of CRC lesions submitted to complementary surgery or with at least one follow-up endoscopy were included. Results: From 2255 colorectal ESDs, 381 (17%) were non-curative, and 135 of them were performed in CRC lesions. Residual lesion was observed in 24 (18%) patients. Surgery was performed in 96 patients, and 76 (79%) had no residual lesion in the colorectal wall or in the lymph nodes. Residual lesion rate for SM1 cancers was 0%, and for >SM1 cancers was also 0% if no other risk factors were present. Independent risk factors for lymph node metastasis were poor differentiation and lymphatic permeation (NC-Lymph score). Risk factors for the presence of residual lesion in the wall was piecemeal resection, poor differentiation and positive or indeterminate vertical margin (NC-Wall score). Conclusions: Lymphatic permeation or poor differentiation warrants surgery due to the high risk of lymph node metastasis, mainly in >SM1 cancers. In the remaining cases, en-bloc and R0 resections determine low risk of residual lesion in the wall. Our scores can be a useful tool for the management of patients submitted to non-curative colorectal ESDs.

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Section: Discussionsupporting

confidence: 89%

Risk of residual neoplasia after a noncurative colorectal endoscopic submucosal dissection for malignant lesions: a multinational study

et al. 2022

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“…Nishimura et al . made similar suggestions, consistent with similar studies 35–38 . EVG (OR 5.3 [95% CI 1.8–15.5]) is reportedly more predictive of LNM than HE staining alone (OR 1.4 [95% CI 0.4–4.7]) 37 .…”

Section: Discussionsupporting

confidence: 86%

Current problems and perspectives of pathological risk factors for lymph node metastasis in T1 colorectal cancer: Systematic review

Ichimasa

Kudo

Miyachi

et al. 2022

Digestive Endoscopy

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With the prevalence of endoscopic submucosal dissection and endoscopic full thickness resection, which enable complete resection of T1 colorectal cancer with a negative margin, the treatment strategy following endoscopic resection has become more important. The necessity of secondary surgical resection is determined on the basis of the risk of lymph node metastasis according to the histopathological findings of resected specimens because ~10% of T1 colorectal cancer cases have lymph node metastasis. The current Japanese treatment guidelines state four risk factors for lymph node metastasis: lymphovascular invasion, histological differentiation, depth of submucosal invasion, and tumor budding. These guidelines have succeeded in stratifying the low‐risk group for lymph node metastasis, in which endoscopic resection alone is acceptable for cure. On the other hand, there are some problems: there is variation in diagnosis methods and low interobserver agreement for each pathological factor and 90% of surgical resections are unnecessary, with lymph node metastasis negativity. To ensure patients with T1 colorectal cancer receive more appropriate treatment, these problems should be addressed. In this systematic review, we gave some suggestions to these practical issues of four pathological factors as predictors.

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“…As mentioned, these results are difficult to compare with the limited available curative resection rates for ESD in T1 CRC. A recent large multicenter study from Japan reported a strict curative resection rate of 24.8 % [31]. Further study is necessary to determine whether sm2-3 invasion can be disregarded as a risk factor.…”

Section: Primary Treatment (N = 97)mentioning

confidence: 99%

Endoscopic full-thickness resection of T1 colorectal cancers: a retrospective analysis from a multicenter Dutch eFTR registry

et al. 2021

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Background and study aims: Complete endoscopic resection and accurate histological evaluation for T1 colorectal cancer (CRC) is critical to determine subsequent treatment. Endoscopic Full-Thickness Resection (eFTR) is a new treatment option for T1 CRC <2cm. We aim to report clinical outcomes and short-term results. Patients and methods: Consecutive eFTR procedures for T1 CRC, prospectively recorded in our national registry between November 2015 and April 2020, were retrospectively analysed. Primary outcomes were technical success and R0 resection. Secondary outcomes were histological risk-assessment, curative resections, adverse events and short-term outcomes. Results: We included 330 procedures: 132 primary resections and 198 secondary scar resections after incomplete T1 CRC resection. Overall technical success, R0 resection and curative resection rates were 87.0% (95% CI [82.7 – 90.3%]), 85.6% (95% CI [81.2 – 89.2%]) and 60.3% (95% CI [54.7 – 65.7%]). Curative resection rate for primary resected T1 CRC was 23.7% (95% CI [15.9 – 33.6%]) and 60.8% (95% CI [50.4 – 70.4%]) after excluding deep submucosal invasion as risk-factor. Risk-stratification was possible in 99.3%. Severe adverse event rates was 2.2%. Additional oncologic surgery was performed in 49/320 (15.3%), with residual cancer in 11/49 (22.4%). Endoscopic follow-up was available in 200/242 (82.6%), with a median of 4 months and residual cancer in 1 (0.5%) following an incomplete resection. Conclusions: eFTR is a relatively safe and effective method to resect small T1 CRC, both as primary and secondary treatment. eFTR can expand endoscopic treatment options for T1 CRC and could help to reduce surgical overtreatment. Future studies should focus on long-term outcomes.

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Clinical significance of immunohistochemical lymphovascular evaluation to determine additional surgery after endoscopic submucosal dissection for colorectal T1 carcinoma

Cited by 17 publications

References 36 publications

Risk of residual neoplasia after a noncurative colorectal endoscopic submucosal dissection for malignant lesions: a multinational study

Risk of residual neoplasia after a noncurative colorectal endoscopic submucosal dissection for malignant lesions: a multinational study

Current problems and perspectives of pathological risk factors for lymph node metastasis in T1 colorectal cancer: Systematic review

Endoscopic full-thickness resection of T1 colorectal cancers: a retrospective analysis from a multicenter Dutch eFTR registry

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