Prognostic factors in colorectal carcinomas arising in adenomas: Implications for lesions removed by endoscopic polypectomy

Haggitt, Rodger C.; Glotzbach, Raymond E.; Soffer, Edward E.; Wruble, Lawrence D.

doi:10.1016/0016-5085(85)90333-6

Cited by 685 publications

(506 citation statements)

References 14 publications

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“…Many investigators 1,2,5,6,11 agree that the depth of a submucosal invasion is an important risk factor for lymph node metastasis. We estimated the depth, width, and area of submucosal invasion as an index of the degree of submucosal invasion.…”

Section: Discussionmentioning

confidence: 99%

“…1,7,18 Since only 26% of submucosal invasive colorectal cancers with lymphatic permeation show metastasis to the lymph nodes, use of lymphatic permeation as an indicator of lymph node involvement would result in about 75% of patients undergoing unnecessary resection of the lymph nodes. Thus, we examined the relation between lymphatic distance and lymph node metastasis with a view to decrease overtreatment.…”

Section: Discussionmentioning

confidence: 99%

“…If these criteria of ours had been applied to resection of the colon in the 140 cases in this study, only 50 patients (including all 13 with lymph node metastasis) would have undergone additional colectomy, 37 of whom would have actually been overtreated. On the other hand, applying the criteria of Haggit et al 1 Haggit 2 or Nivatvongs et al 5 , 130 of 140 patients would have undergone additional colectomy, 117 of whom would have been overtreated. Both specificity and over all accuracy of our criteria showed higher value than the criteria of Haggit et al Therefore, the indication criteria that we present for additional colectomy after endoscopic resection of submucosal invasive cancer of the colorectum enable greater accurate selection of patients who will undergo further surgical treatment after endoscopic resection.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, pathologists are increasingly encountering submucosal invasive colorectal carcinomas, which are endoscopically resected. Since 10% or less of cases of submucosal invasive cancer had metastasized to the lymph nodes according to previous reports, [1][2][3][4][5][6][7] additional surgical resection of the colorectum after endoscopic resection of submucosal invasive cancer is needed for curative treatment. However, there are currently no universally accepted indications and criteria for additional surgical resection of the colorectum after endoscopic resection of submucosal invasive cancer.…”

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Analysis of pathological risk factors for lymph node metastasis of submucosal invasive colon cancer

et al. 2004

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There are currently no universally accepted indications and criteria for additional surgical resection of the colorectum after endoscopic resection of the submucosal invasive cancer. The purpose of the present study is to establish accurate indications and criteria for additional surgical resection of the colorectum, based on the prediction of lymph node metastasis, after endoscopic resection of the submucosal invasive cancer. We investigated 140 submucosal invasive colorectal cancers and analyzed the pathologic factors of lymph node metastasis. The tumors were evaluated for pathologic factors in the invasive area of the submucosal carcinoma and were compared between the cases with lymph node metastasis and those without lymph node metastasis. Lymph node metastasis was observed in 13 cases (9%). Univariate logistic regression analysis showed that the depth of invasion, cribriform-type structural atypia, absence of lymphoid infiltration, lymphatic permeation, and venous permeation were statistically significant as risk factors for lymph node metastasis. Multivariate logistic regression analysis showed that the important risk factors included, in decreasing order, lymphatic permeation, absence of lymphoid infiltration, cribriform-type structural atypia, venous permeation, and depth of invasion. Submucosal invasion of 2 mm or more, and/or, depth of lymphatic permeation of 2 mm or more are risk factors for lymph node metastasis. The pathologic criteria based on our results for additional colectomy enables greater accuracy selection of patients who will undergo further surgical treatment after endoscopic resection. Keywords: colorectal cancer; submucosal invasive cancer; criteria for additional colectomy; risk factor of lymph node metastasis Endoscopic resection has become the established standard treatment for mucosal carcinoma and adenoma of the colon. Submucosal invasive cancer may not be diagnosed, in some cases, until after endoscopic resection. Thus, pathologists are increasingly encountering submucosal invasive colorectal carcinomas, which are endoscopically resected. Since 10% or less of cases of submucosal invasive cancer had metastasized to the lymph nodes according to previous reports, 1-7 additional surgical resection of the colorectum after endoscopic resection of submucosal invasive cancer is needed for curative treatment. However, there are currently no universally accepted indications and criteria for additional surgical resection of the colorectum after endoscopic resection of submucosal invasive cancer. As a result, many cases (the remainder, except cases with lymph node metastasis, ie, about 90% of the total cases) involving additional surgical resection of the colorectum constitute overtreatment. Establishment of accurate criteria for additional surgical resection of the colorectum, based on the prediction of lymph node metastasis, after endoscopic resection of submucosal invasive cancer is more than necessary. Thus, toward this goal, we investigated and analyzed the pathologic factors of lymph no...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Analysis of pathological risk factors for lymph node metastasis of submucosal invasive colon cancer

et al. 2004

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“…A detailed discussion of these features is beyond the scope of this manuscript but includes adequacy of excision of the tumour to a clearance of >1 mm, the differentiation of the tumour, lymphatic or vascular invasion, Haggit (in polypoid lesions) [50] or Kikuchi level (in sessile lesions) [51] and finally the suspicion of lymph node metastases on local imaging with MRI or ERUS.…”

Section: Management Of Early Rectal Cancer and The Malignant Polypmentioning

confidence: 99%

Paradigm Shift in the Management of Rectal Cancer

Rawat

Evans

2014

Indian J Surg

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Surgery for rectal cancer in the pre-Total Mesorectal Excision (TME) era was associated with high local recurrence rates. The widespread adoption of the TME technique together with the addition of neoadjuvant oncological therapies have reduced local failure rates and improved survival for patients with rectal cancer. Advances in our knowledge, better understanding of tumour biology and refinement in minimal access techniques and equipment have significantly changed the management of rectal cancer. This paper reviews these changes and proposes a paradigm shift in how rectal cancer management is conceptualised and treated, such that the treatment of rectal cancer is separated into early tumours (potentially suitable for local excison), TME tumours (optimally managed by TME) and beyond TME tumours (optimally managed by multivisceral resection outside the TME plane).

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Follow-up of patients with colonic polyps containing severe atypia and invasive carcinoma. Compliance, recurrence, and survival

Eckardt

Fuchs

Kanzler

et al. 1988

Cancer

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Between January 1975 and December 1984 1769 polyps were endoscopically removed from 1219 patients. Eight percent of these patients had polyps containing severe atypia and 5.0% had polyps containing invasive cancer. A close postoperative surveillance program was followed by only a few patients, but compliance improved with longer follow-up intervals. Metachronous polyps were observed with similar frequency in patients with benign polyps (34.8%) and those with polyps containing severe atypia (23.8%) or cancer (41.7%). Patients in whom malignant polyps were endoscopically removed had a 5-year survival rate of 84.3% that did not differ from that of patients' whose polyps contained severe atypia (79.0%). It was concluded that endoscopic removal of malignant polyps with favorable histologic conditions does not impair survival. The follow-up program of these patients should be adapted to that of patients with benign polyps, a procedure that may even improve patient compliance.

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Prognostic factors in colorectal carcinomas arising in adenomas: Implications for lesions removed by endoscopic polypectomy

Cited by 685 publications

References 14 publications

Analysis of pathological risk factors for lymph node metastasis of submucosal invasive colon cancer

Analysis of pathological risk factors for lymph node metastasis of submucosal invasive colon cancer

Paradigm Shift in the Management of Rectal Cancer

Follow-up of patients with colonic polyps containing severe atypia and invasive carcinoma. Compliance, recurrence, and survival

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