Location of Early Colorectal Cancers at Fold-Top May Reduce the Risk of Lymph Node Metastasis

Pan, Wensheng; Terai, Takeshi; Abe, Satoshi; Sakamoto, Naoto; Nagahara, Akihito; Ohkusa, Toshifumi; Ogihara, Tatsuo; Sato, Nobuhiro

doi:10.1007/s10350-006-0508-3

Cited by 3 publications

(1 citation statement)

References 20 publications

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“…( 6,18,19 ) Pan et al. ( 20 ) also reported that early invasive colorectal cancers at the fold‐top or with a long distance from the muscularis mucosae to the muscularis propria have a lower tendency to metastasize to lymph nodes. These studies indicate that the lower rate of lymph node metastasis in pedunculated type early invasive colorectal cancers could be elucidated by the presence of a greater muscularis mucosae to muscularis propria distance.…”

Section: Discussionmentioning

confidence: 99%

Risk of lymph node metastasis in patients with pedunculated type early invasive colorectal cancer: A retrospective multicenter study

Matsuda¹,

Fukuzawa

Uraoka

et al. 2011

Cancer Science

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Depth of invasion in early invasive colorectal cancer is considered an important predictive factor for lymph node metastasis. However, no large-scale reports have established the relationship between invasion depth of pedunculated type early invasive colorectal cancers and risk of lymph node metastasis. The aim of this retrospective cohort study was to clarify the risk of lymph node metastasis in pedunculated type early invasive colorectal cancers in a large series. Patients with pedunculated type early invasive colorectal cancer who underwent endoscopic or surgical resection at seven referral hospitals in Japan were enrolled. Haggitt's line was used as baseline and the invasion depth was classified into two groups, head invasion and stalk invasion. The incidence of lymph node metastasis was investigated between patients with head and stalk invasion. We analyzed 384 pedunculated type early invasive colorectal cancers in 384 patients. There were 154, 156, and 74 endoscopic resection cases, endoscopic resection followed by surgical operation, and surgical resection cases, respectively. There were 240 head invasion and 144 stalk invasion lesions. Among the lesions treated surgically, the overall incidence of lymph node metastasis was 3.5% (8 ⁄ 230). The incidence of lymph node metastasis was 0.0% (0 ⁄ 101) in patients with head invasion, as compared with 6.2% (8 ⁄ 129) in patients with stalk invasion. Pedunculated type early invasive colorectal cancers pathologically diagnosed as head invasion can be managed by endoscopic treatment alone. (Cancer Sci 2011; 102: 1693-1697 I t has been reported that intramucosal colorectal cancers show no lymph node metastasis and are good candidates for endoscopic resection.(1,2) In contrast, 6-12% of early invasive colorectal cancers (i.e. cancer cells invade through the muscularis mucosae into the submucosal layer but do not extend into the muscularis propria) are associated with lymph node metastasis requiring surgical resection including lymph node dissection for curative treatment.(3-7) Recently, increasing evidence suggests that lesions with submucosal invasion limited to <1000 lm without lymphovascular invasion and ⁄ or poorly differentiated components do not metastasize to lymph nodes.(8) Endoscopic resection is an appropriate treatment for early stage colorectal cancers, however, the resected specimen must be examined to determine whether there is a clinically significant risk of lymph node metastasis that would warrant additional surgery. Colorectal lesions can be subdivided according to endoscopic appearance using the Paris classification (Fig. S1), whereas Haggitt's classification is frequently used to define the depth of invasion of pedunculated lesions.(9) Haggitt and colleagues stratified the level of cancer invasion according to the following criteria: level 0, carcinoma in situ (i.e. has not extended below the muscularis mucosae); level 1, carcinoma invading through the muscularis mucosae but limited to the head of the polyp (i.e. above the junction between the aden...

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Section: Discussionmentioning

confidence: 99%

Risk of lymph node metastasis in patients with pedunculated type early invasive colorectal cancer: A retrospective multicenter study

Matsuda¹,

Fukuzawa

Uraoka

et al. 2011

Cancer Science

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Meta-analysis of Histopathological Features of Primary Colorectal Cancers that Predict Lymph Node Metastases

Glasgow

Bleier

Burgart

et al. 2012

Journal of Gastrointestinal Surgery

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No single histopathological feature of colorectal cancer reliably predicted lymph node metastases. Several risk factors that correlate highly with nodal disease are not routine components of standard pathology reports. Until further research establishes histopathological or molecular patterns for predicting lymph node spread, caution should be exercised when basing treatment decisions solely on these factors.

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Meta-analysis of Predictive Clinicopathologic Factors for Lymph Node Metastasis in Patients with Early Colorectal Carcinoma

et al. 2015

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The objective of this study was to conduct a meta-analysis to determine risk factors that may facilitate patient selection for radical resections or additional resections after a polypectomy. Eligible articles were identified by searches of PUBMED, Cochrane Library and Korean Medical Database using the terms (early colorectal carcinoma [ECC], lymph node metastasis [LNM], colectomy, endoscopic resection). Thirteen cohort studies of 7,066 ECC patients who only underwent radical surgery have been analysed. There was a significant risk of LNM when they had submucosal invasion (≥ SM2 or ≥ 1,000 µm) (odds Ratio [OR], 3.00; 95% confidence interval [CI], 1.36-6.62, P = 0.007). Moreover, it has been found that vascular invasion (OR, 2.70; 95% CI, 1.95-3.74; P < 0.001), lymphatic invasion (OR, 6.91; 95% CI, 5.40-8.85; P < 0.001), poorly differentiated carcinomas (OR, 8.27; 95% CI, 4.67-14.66; P < 0.001) and tumor budding (OR, 4.59; 95% CI, 3.44-6.13; P < 0.001) were significantly associated with LNM. Furthermore, another analysis was carried out on eight cohort studies of 310 patients who underwent additional surgeries after an endoscopic resection. The major factors identified in these studies include lymphovascular invasion on polypectomy specimens (OR, 5.47; 95% CI, 2.46-12.17; P < 0.001) and poorly or moderately differentiated carcinomas (OR, 4.07; 95% CI, 1.08-15.33; P = 0.04). For ECC patients with ≥ SM2 or ≥ 1,000 µm submucosal invasion, vascular invasion, lymphatic invasion, poorly differentiated carcinomas or tumor budding, it is deemed that a more extensive resection accompanied by a lymph node dissection is necessary. Even if the lesion is completely removed by an endoscopic resection, an additional surgical resection should be considered in patients with poorly or moderately differentiated carcinomas or lymphovascular invasion.Graphical Abstract

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Location of Early Colorectal Cancers at Fold-Top May Reduce the Risk of Lymph Node Metastasis

Cited by 3 publications

References 20 publications

Risk of lymph node metastasis in patients with pedunculated type early invasive colorectal cancer: A retrospective multicenter study

Risk of lymph node metastasis in patients with pedunculated type early invasive colorectal cancer: A retrospective multicenter study

Meta-analysis of Histopathological Features of Primary Colorectal Cancers that Predict Lymph Node Metastases

Meta-analysis of Predictive Clinicopathologic Factors for Lymph Node Metastasis in Patients with Early Colorectal Carcinoma

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