Risk Factors for Residual Cancer and Lymph Node Metastasis After Noncurative Endoscopic Resection of Early Colorectal Cancer

Kim, Kwang Min; Eo, Sung June; Shim, Sang Goon; Chang, Dong Kyung; Kim, Young‐Ho; Rhee, Poong–Lyul; Kim, Jae J.; Kim, Jin Yong

doi:10.1097/dcr.0b013e31826942ee

Cited by 21 publications

(16 citation statements)

References 28 publications

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“…Unlike available series recently published in the literature [6,14,15], lympho-vascular invasion, tumour grade and high-grade budding have only marginally influenced treatment plans.…”

Section: Discussionmentioning

confidence: 72%

The management of malignant polyps in colorectal cancer screening programmes: A retrospective Italian multi-centre study

Fasoli

Nienstedt

Carli

et al. 2015

Digestive and Liver Disease

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“…Unlike available series recently published in the literature [6,14,15], lympho-vascular invasion, tumour grade and high-grade budding have only marginally influenced treatment plans.…”

Section: Discussionmentioning

confidence: 72%

The management of malignant polyps in colorectal cancer screening programmes: A retrospective Italian multi-centre study

Fasoli

Nienstedt

Carli

et al. 2015

Digestive and Liver Disease

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“…Therefore, although lymphovascular invasion can also function as a prognostic predictor of residual disease or recurrence, the scientific evidence is less conclusive. Some authors have shown that lymphovascular invasion is correlated with regional lymph node metastasis and recurrence [5, 8, 23, 27, 28], whereas others have reported no association [2, 7, 18, 29]. Analysis on this matter is further complicated by the fact that lymphovascular invasion is not often seen in endoscopic resection specimens of early colorectal cancer.…”

Section: Discussionmentioning

confidence: 99%

Association of Poor Differentiation or Positive Vertical Margin with Residual Disease in Patients with Subsequent Colectomy after Complete Macroscopic Endoscopic Resection of Early Colorectal Cancer

Kim

Lee

Jeon

et al. 2017

Gastroenterology Research and Practice

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In the presence of unfavorable pathologic results after endoscopic resection of colorectal cancer, colectomy is routinely performed. We determined the risk factors for residual diseases in patients with colectomy after complete macroscopic endoscopic resection of early colorectal cancer. We identified consecutive patients who underwent endoscopic resection of early colorectal cancer and subsequently underwent colectomy, from January 2011 to December 2014. Clinicopathologic risk factors related to the residual disease were analyzed. In total, 148 patients underwent endoscopic resection and subsequent colectomy. Residual disease on colectomy was noted in 16 (10.9%) patients. The rates of poorly differentiated/mucinous histology (p = 0.028) and of positive or unknown vertical resection margin (p = 0.047) were higher in patients with residual disease than in those without. In multivariate analysis, a poorly differentiated/mucinous histology and positive or unknown vertical resection margin were significantly associated with residual disease (odds ratio = 7.508 and 2.048, p = 0.015 and 0.049, resp.). After complete macroscopic endoscopic resection of early colorectal cancer, there is a greater need for additional colectomy in cases with a positive or unknown vertical resection margin or a poorly differentiated/mucinous histology, because of their higher risk of residual cancer and lymph node metastasis.

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“…Positive (<1 mm) or unknown polypectomy margins were associated with residual disease in the colonic wall, and lymphovascular invasion was associated with lymph node metastases. Kim et al [20] published a series of 85 radicalized polypectomy (23.5 % for rectal polyps), showing that positive vertical margin (>pT1sm1) and inadequate lifting sign could be predictors of the presence of residual tumor or lymph node metastases in surgical specimens after non-curative endoscopic resection for early CRC. This study analyzes the role of TEM in the management of MRPs.…”

Section: Discussionmentioning

confidence: 99%

Transanal endoscopic microsurgery after endoscopic resection of malignant rectal polyps: a useful technique for indication to radical treatment

et al. 2013

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Background Management of malignant rectal polyps (MRPs) after endoscopic polypectomy (EP) is still debated. It is sometimes difficult to decide whether to simply follow-up (FU) or to treat such a removed lesion. Transanal endoscopic microsurgery (TEM) could have a role both in T staging and in treating MRPs after EP. Methods Patients who underwent a full-thickness TEM within 3 months after an EP between January 2008 and October 2012 were retrospectively analyzed. If post-TEM histology showed locally advanced rectal cancer, patients underwent a total mesorectal excision (TME) within 4-6 weeks. Patients without malignant disease or pT1sm1 cancers at post-TEM histology were followed up every 3 months for 2 years with clinical examination, flexible rectal endoscopy, and neoplastic markers monitoring. Results A total of 39 patients were included. Post-EP histology was adenocarcinoma in 27/39 cases (69.2 %) and adenoma in 12/39. Mean operative time was 64.2 min; no 30-day mortality occurred; 30-day morbidity was 2.7 % (rectal bleeding in 1/39 cases). Post-TEM histology showed a T2 cancer in 5/39 patients, four with and one without a previous cancer diagnosis, who were further treated by TME (four RARs and one APR) and are disease free with a mean FU of 24.2 months. Post-TEM histology showed adenoma in 10/39 cases and fibrosis in 24/39. These patients are disease free with a mean FU of 13 months. Conclusions A full-thickness TEM after EP of MRPs can establish the presence of residual malignant disease and its depth of invasion, precisely defining the indication to TME. In event of benign post-EP histology, TEM must be performed in presence of macroscopic residual disease, in order to obtain an RO resection and finally exclude cancer, while, in absence of macroscopic residual disease, only close FU is required. Keywords Rectal polyps Endoscopic mucosal resection Transanal endoscopic microsurgery Total mesorectal excision Colorectal cancer (CRC) represents the most frequently diagnosed neoplasm in Europe (436,000 new cases/year, i.e. 13.6 % of diagnosed tumors) [1] and accounts for 8 % of deaths for neoplasm in the world and 12.2 % in Europe [2]. With

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Risk Factors for Residual Cancer and Lymph Node Metastasis After Noncurative Endoscopic Resection of Early Colorectal Cancer

Abstract: There is a greater need for additional surgery in cases with positive vertical resection margin or inadequate lifting sign, because the risk of residual tumor and lymph node metastasis is higher than in other cases.

Cited by 21 publications

References 28 publications

The management of malignant polyps in colorectal cancer screening programmes: A retrospective Italian multi-centre study

The management of malignant polyps in colorectal cancer screening programmes: A retrospective Italian multi-centre study

Association of Poor Differentiation or Positive Vertical Margin with Residual Disease in Patients with Subsequent Colectomy after Complete Macroscopic Endoscopic Resection of Early Colorectal Cancer

Transanal endoscopic microsurgery after endoscopic resection of malignant rectal polyps: a useful technique for indication to radical treatment

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