Risk of Lymph Node Metastasis in T1 Carcinoma of the Colon and Rectum

Nascimbeni, Riccardo; Burgart, Lawrence J.; Nivatvongs, Santhat; Larson, Dirk R.

doi:10.1007/s10350-004-6147-7

Cited by 645 publications

(476 citation statements)

References 33 publications

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“…The high level of the pT increases the presence of LVI. In addition, Nascimbeni et al also demonstrated that T1 CRC with LVI, sm3 depth of invasion, and location in the lower third of the rectum have a high risk of LMN [13]. Although it was not shown in our study, the site of tumor may increase the LVI.…”

Section: Discussioncontrasting

confidence: 60%

“…However, some tumors, although diagnosed in a small size, may already have LNM and even distant metastasis. The incidence of LNM in the submucosal invasive CRC has been reported to be approximately 7-15 %, and the treatment consists of endoscopic polypectomy, local excision for selected patients, or radical resection [12][13][14]. Many series in which long-term follow-up was performed have revealed that the local recurrence rate is high although submucosal invasive CRC can be expected to be treated by local excision without adjuvant therapy [9,10].…”

Section: Discussionmentioning

confidence: 99%

“…Identification of the risk factors for LNM is crucial in selecting appropriate therapeutic modalities for submucosal invasive CRC. Various risk factors for LNM have been reported, such as the depth of submucosal invasion (sm3), peritumoral LVI, poorly differentiated cancer, and tumor cell dissociation [13][14][15]. Choi et al demonstrated that LVI was a risk factor for LNM in the univariate analysis [16].…”

Section: Discussionmentioning

confidence: 99%

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The Factors Effecting Lymphovascular Invasion in Adenocarcinoma of the Colon and Rectum

et al. 2013

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Adenocarcinomas of the colon and rectum are the most common gastrointestinal malignancy, and lymph node metastases are established as a prognostic factor. Lymphovascular invasion has been recognized as an indication of lymph node metastases. This prompted us to investigate the features of primary tumor that may serve as a risk factor for lymphovascular invasion in colorectal carcinoma. Clinical and pathologic tissue data of colorectal carcinoma treated in our hospital were retrieved from the computer files at Haydarpasa Numune Education and Research Hospital, from June 1998 to December 2010, retrospectively. We excluded all patients who have two-thirds distal rectal carcinoma to rule out neoadjuvant treatment bias. Tissues from the specimens were stained with standard hematoxylin and eosin. Clinical data including age and sex of patient, location and diameter of tumor, perineural invasion, peritumoral lymphocytic infiltration, tumor grade, lymphovascular invasion, Pathologic T level (pT), and lymph node metastasis were recorded. Lymphovascular invasion was present only in 43 patients out of 108. Only pT and lymph node metastases were found to be statistically significant related to lymphovascular invasion (p=0.04 and p<0.001). Perineural invasion, pT, and peritumoral lymphocytic infiltration are the factors with p<0.2 in the univariate analysis that were investigated with multivariate analysis, but no factor was found as an independent prognostic factor for lymphovascular invasion. Lymphovascular invasion is significantly related to lymph node metastases. Only pT is found as a factor that increases the lymphovascular invasion.

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Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Factors Effecting Lymphovascular Invasion in Adenocarcinoma of the Colon and Rectum

et al. 2013

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“…[4][5][6] When histopathologic examination of tumors removed by endoscopic procedures indicates invasion into the submucosa (T1 colorectal cancer), additional major surgery is recommended because of the risk of lymph node metastasis. 7 The frequency of lymph node metastasis, however, is <15% based on large-scale studies, [8][9][10][11][12][13][14][15] and 85% of T1 colorectal cancer patients are cured by endoscopic treatment alone. The establishment of reliable criteria for discriminating patients with a high risk of lymph node metastasis from those with a low risk is thus an important issue in terms of providing adequate treatment to patients with T1 colorectal cancer.…”

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confidence: 99%

A three-tier classification system based on the depth of submucosal invasion and budding/sprouting can improve the treatment strategy for T1 colorectal cancer: a retrospective multicenter study

et al. 2015

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More than 85% of patients with T1 colorectal cancer have no lymph node metastasis and can be cured by endoscopic resection. To avoid unnecessary surgery after complete endoscopic resection, accurate histologic methods for evaluating resected specimens are needed to discriminate those at high risk for lymph node metastasis. A retrospective multi-institutional, cross-sectional study of 806 T1 colorectal cancer patients was conducted. A budding/sprouting score was incorporated for predicting lymph node metastasis in addition to other parameters, including the depth of submucosal invasion, histologic grade, and lymphovascular invasion. Lymph node metastasis was detected in 97 patients. Independent predictors of lymph node metastasis by multivariate analysis were depth of submucosal invasion ≥ 1000 μm (odds ratio (95% confidence interval) = 5.56 (2.14-19.10)) and high-grade budding/sprouting (3.14 (1.91-5.21)). Among lesions with a depth of submucosal invasion ≥ 1000 μm, lymph node metastasis was detected in 59 (29%) of 207 patients with high-grade budding/ sprouting, and in 34 (9%) of 396 with low-grade budding/sprouting. Lymph node metastasis was detected in only 4 (2%) of 203 lesions with a depth of submucosal invasion o 1000 μm. Of these four tumors, three invaded lymphatic and/or venous vessels. Thus, the risk for lymph node metastasis can be classified into three groups: high risk with a depth of submucosal invasion ≥ 1000 μm and high-grade budding/sprouting, intermediate-risk with a depth of submucosal invasion ≥ 1000 μm and low-grade budding/sprouting, and low-risk with a depth of submucosal invasion o1000 μm. These findings revealed that a depth of submucosal invasion ≥ 1000 μm and high-grade budding/sprouting are powerful predictive parameters for lymph node metastasis in T1 colorectal cancer. This three-tier risk classification system will facilitate the decision for additional major surgery for T1 colorectal cancer patients after successful endoscopic treatment.

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“…The frequency of lymph node metastases is proportional to the degree of depth being 2, 8, and 23 %, respectively [6]. The Paris classification [3], revised in Kyoto in 2008 [7], defines every lesion extended no more than 1 mm in the submucosal layer as 'sm1'.…”

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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 of Lymph Node Metastasis in T1 Carcinoma of the Colon and Rectum

Cited by 645 publications

References 33 publications

The Factors Effecting Lymphovascular Invasion in Adenocarcinoma of the Colon and Rectum

The Factors Effecting Lymphovascular Invasion in Adenocarcinoma of the Colon and Rectum

A three-tier classification system based on the depth of submucosal invasion and budding/sprouting can improve the treatment strategy for T1 colorectal cancer: a retrospective multicenter study

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

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