The clinical significance of invasion of veins by rectal cancer

Talbot, Ian C.; Ritchie, Sheila; Leighton, Monica; Hughes, Anthony; Bussey, H. J. R.; Morson, B. C.

doi:10.1002/bjs.1800670619

Cited by 360 publications

(194 citation statements)

References 11 publications

Supporting

Mentioning

178

Contrasting

Unclassified

Order By: Relevance

“…Owing to the larger circumference of the extramural tissues, we believe that false negative diagnoses regarding extramural venous invasion are mainly the result of sampling errors. Talbot and colleagues 10 and Dirschmid and colleagues 20 emphasise the importance of cutting multiple tangential blocks from the periphery of the tumour to facilitate the diagnosis of extramural venous invasion. The number of blocks is directly related to the size of the tumour; therefore, minimum standards for declaring a specimen negative for venous invasion have not been clearly defined in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…The reported incidence of venous invasion in CRC specimens varies between 10% and 89.5%. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] To a certain extent, this variance may indicate currently unidentified inherent differences between patient populations, and it obviously reflects differences in tumour differentiation and stage among the reported cohorts. Owing to the focal nature of vein invasion and to the non-continuous nature of the process of tumour embolism, it appears that pure chance also influences the identification of venous invasion.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Conclusions from a study of venous invasion in stage IV colorectal adenocarcinoma

Sternberg¹,

Amar²,

Alfici³

et al. 2002

Journal of Clinical Pathology

View full text Add to dashboard Cite

Aims: Venous invasion is an established predictor of prognosis in colorectal cancer (CRC). The reported incidence of venous invasion in CRC specimens varies between 10% and 89.5%, mainly as a result of interobserver variability and differences in specimen processing (for example, staining with haematoxylin and eosin (H+E) alone versus the addition of an elastic fibre stain). This study was performed with three purposes in mind, namely: (1) To assess and compare the incidence of venous invasion diagnosed on H+E stained tissue versus tissue stained with both H+E and an elastic fibre stain. (2) To estimate the inherent false negative rate associated with the diagnosis of venous invasion by histopathological evaluation of resected CRC specimens. (3) To compare the resulting data regarding incidence, quantity, site, and type of venous invasion to the pertinent literature. Methods: Venous invasion was assessed on sections from 81 CRCs resected from patients with synchronous distant metastases (hepatic and non-hepatic). Only stage IV tumours were studied for the following reasons: (1) it can be assumed that in all patients with distant haematogenous metastases venous invasion had occurred, thus enabling the false negative rate to be calculated; (2) there can be no dispute about the clinical relevance of the various characteristics of venous invasion identified in the tumours of patients with synchronous distant haematogenous metastases; and (3) to eliminate the effect of variance in tumour stage on the incidence of venous invasion. Initially, H+E stained sections were studied for venous invasion. Sections that were negative or questionable with regard to venous invasion were then stained with an elastic fibre stain, and a second search for venous invasion was carried out. Venous invasion was characterised by incidence, quantity, type, and site. The χ 2 test for independence was used to compare the incidence of venous invasion in colonic versus rectal and rectosigmoid primary tumours, and in patients with hepatic versus non-hepatic metastases. Results: Venous invasion was identified in 42 (51.9%) (of the 81 specimens on H+E stained sections. The addition of the elastic fibre stain enabled the diagnosis of venous invasion in 15 (38.5%) of the remaining 39 specimens, increasing the overall incidence to 57 of 81 cases (70.4%). Of the 57 positive specimens, venous invasion was minimal in 27 (47.4%), intermediate in five, (8.8%) and massive in 25 (43.9%). Only intramural veins were involved in 18 (31.6%), only extramural veins in 26 (45.6%), and both intramural and extramural veins in 13 (22.8%) of the 57 positive specimens. The filling type of venous invasion was found in 41 (71.9%), the floating type in 28 (49.1%), and the infiltrating type in six (10.5%) of the 57 positive specimens. There was no significant difference between the incidence of venous invasion in the colon (42 of 60; 70%) versus rectal and rectosigmoid tumours (15 of 21; 71.4%; p = 0.8539), nor in the incidence of venous invasion in patients with hepatic (...

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Conclusions from a study of venous invasion in stage IV colorectal adenocarcinoma

Sternberg¹,

Amar²,

Alfici³

et al. 2002

Journal of Clinical Pathology

View full text Add to dashboard Cite

show abstract

“…B. nach intraoperativer Tumoreröffnung) oder eines pathologischen Befundes (z. B. erhöhtes Risiko für Fernmetastasen bei Invasion perikolischer Venen [1242,1243], angiolymphatischer Invasion [1244,1245], G3 / G4-Tumoren oder pT2-Tumoren) eine engmaschigere Nachsorge angezeigt sein. Hierbei erwies sich die alleinige Bestimmung des CEA als ausreichend [1240].…”

Section: Hintergrundunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

148

View full text Add to dashboard Cite

“….Features on histological examination of resected specimens predict increased risk of postoperative systemic recurrence including more than 5mm invasion of disease through the muscularis into the mesorectum (≥T3c) [24,25], extra-mural vascular invasion (EMVI) [26] and lymph node involvement (LN+) [27]. For patients with such features, with optimum surgery and selective use of pre-operative radiotherapy, DM relapse is Gollins approximately 6-fold greater than LR (approximately 30% vs. 5%) [6,7,28] and is now the main cause of death.…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer

Gollins

Sebag‐Montefiore

2016

Clinical Oncology

View full text Add to dashboard Cite

Improved surgical technique plus selective pre-operative radiotherapy, has decreased rectal cancer pelvic local recurrence (LR) from historically 25%, down to approximately 5-10%. However, this improvement has not reduced distant metastatic relapse, the main cause of death and a key issue in rectal cancer management.The current standard is local pelvic treatment (surgery +/-pre-operative radiotherapy) followed by adjuvant chemotherapy (AC), depending on resection histology. For circumferential resection margin (CRM)-threatened cancer on baseline MRI, downstaging long-course pre-operative chemoradiation (LCPCRT) is generally used. However, for non-CRM threatened disease, varying approaches are currently adopted in the UK, including straight to surgery (STS), short-course pre-operative radiotherapy (SCPRT) and LCPCRT.Clinical trials are investigating intensification of concurrent chemoradiation. There is also increasing interest in investigating pre-operative neoadjuvant chemotherapy (NAC) as a way of exposing micro-metastatic disease to full dose systemic chemotherapy as early as possible and potentially reducing metastatic relapse.Phase II trials suggest that this strategy is feasible, with promising histological response and low rates of tumour progression during NAC. Phase III trials are needed to determine the benefit of NAC when added to standard therapy and also to determine if it can be used instead of neoadjuvant radiotherapy based schedules.

show abstract

The clinical significance of invasion of veins by rectal cancer

Cited by 360 publications

References 11 publications

Conclusions from a study of venous invasion in stage IV colorectal adenocarcinoma

Conclusions from a study of venous invasion in stage IV colorectal adenocarcinoma

S3-Leitlinie – Kolorektales Karzinom

Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer

Contact Info

Product

Resources

About