Factors associated with complete endoscopic resection of an invasive adenocarcinoma in a colorectal adenoma

Quintas, Paola; Cubiella, Joaquín; Couto, Ignacio; Bujanda, Luís; Cobian, Carol; Castro, Inês; Fernández-Seara, Javier

doi:10.4321/s1130-01082012001000004

Cited by 3 publications

(1 citation statement)

References 26 publications

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“…Size and sessile or flat morphology of the polyp are associated with incomplete endoscopic resection (30). To our knowledge there is no study stressing, what we believe to be a frequent western countries' problem, related to poor endoscopic experience in ESD, the spread use of piecemeal resection in larger lesions, and with the poor experience of pathologists in evaluating submucosal behaviour of tumors without the complete wall specimen.…”

Section: Discussionmentioning

confidence: 90%

Oncological outcomes after endoscopic removal of malignant colorectal polyps

Gonçalves

Fontainhas

Caetano

et al. 2013

Rev. esp. enferm. dig.

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Objective: malignant colorectal polyp, defined by submucosally invasive adenocarcinoma, is the earliest form of clinically relevant colorectal cancer (CRC). After endoscopic resection additional surgery may be necessary, although decision criteria remain debatable. The objective of this study was to assess oncologic outcomes in terms of locoregional disease and to identify areas of improvement that may facilitate patients' management.Methods: retrospective study of 40 patients with T1 CRC endoscopically resected between 2007 and 2012. Clinicopathological features were assessed and correlated with residual disease (RD), defined as presence of adenocarcinoma in intestinal wall and/ or lymph nodes.Results: thirty-one patients underwent surgery while 9 were followed-up. After surgery, RD was confirmed in 15 (48.4 %) patients: 8 (53.3 %) wall disease, 5 (33 %) nodal metastasis, and 2 (13.3 %) with both. No recurrence was detected in the follow-up group. The characteristics of the lesions that were associated with DR were sessile configuration (p = 0.03), the degree of differentiation G3 (p = 0.01) and intercepted/indeterminate margins (p = 0.01). Twenty-two patients were operated because of inadequate evaluation, mainly due to piecemeal resection, and half of them were disease free. Postoperative complications were found in 9 (30 %) patients, mainly anastomotic leakage that was associated with rectum anterior resection (p = 0.03).Conclusions: surgery should be considered in the presence of any risk factor for residual disease, while follow-up can be offered in low risk settings. Was also demonstrated a clear need for technical improvement in endoscopic resection and pathology evaluation in order to prevent unnecessary surgeries.

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Section: Discussionmentioning

confidence: 90%

Oncological outcomes after endoscopic removal of malignant colorectal polyps

Gonçalves

Fontainhas

Caetano

et al. 2013

Rev. esp. enferm. dig.

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Complete Resection of Colorectal Adenomas: What Are the Important Factors in Fellow Training?

Choi

Lee²,

Park³

et al. 2014

Dig Dis Sci

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Characteristics of right-sided colonic neoplasia and colonoscopy barriers limiting their early detection and prognosis: a review of the literature

Fischbach

Elsome²,

Amlani

2018

Expert Review of Gastroenterology & Hepatology

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Colonoscopy provides less protection from colorectal cancer in the right colon than the left. Areas covered: This review examines patient outcomes and colonoscopy success rates to identify factors that limit the protective effect of colonoscopy in the right colon. The MEDLINE and Embase databases were searched for literature from 2000 onwards, on the long-term outcomes and differences in screening practice between the right and left colon. In total, 12 systematic reviews (including nine meta-analyses) and 44 primary data records were included. Differences in patient outcomes and colonoscopy practice were identified between the right and left colon, suggesting that several factors, many of which disproportionally affect the right colon, impact lesion detection rates. Shorter withdrawal times reduce detection rates, while longer times significantly increase detection; mostly of adenomas in the right colon. Colonoscope attachments often only show a significant improvement in detection rates in the right colon, suggesting detection is more challenging due to visibility of the right colonic mucosa. Higher bowel cleansing grades significantly improve detection rates in the right colon compared to the left. Expert commentary: These findings confirm the need for continued improvement of colonoscopy effectiveness, and obligatory quality assessment, overall and especially in the right colon.

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Factors associated with complete endoscopic resection of an invasive adenocarcinoma in a colorectal adenoma

Cited by 3 publications

References 26 publications

Oncological outcomes after endoscopic removal of malignant colorectal polyps

Oncological outcomes after endoscopic removal of malignant colorectal polyps

Complete Resection of Colorectal Adenomas: What Are the Important Factors in Fellow Training?

Characteristics of right-sided colonic neoplasia and colonoscopy barriers limiting their early detection and prognosis: a review of the literature

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