Clinical outcomes of positive resection margin after endoscopic mucosal resection of early colon cancers

Abstract

Background/AimsWhen determining the subsequent management after endoscopic resection of the early colon cancer (ECC), various factors including the margin status should be considered. This study assessed the subsequent management and outcomes of ECCs according to margin status. MethodsWe examined the data of 223 ECCs treated by endoscopic mucosal resection (EMR) from 215 patients during 2004 to 2014, and all patients were followed-up at least for 2 years. ResultsAccording to histological analyses, the margin statuses of all lesions after EMR were as follows: 138 cases (61.9%) were negative, 65 cases (29.1%) were positive for dysplastic cells on the resection margins, and 20 cases (8.9%) were uncertain. The decision regarding subsequent management was affected not only by pathologic outcomes but also by the endoscopist’s opinion on whether complete resection was obtained. Surgery was preferred if the lesion extended to the submucosa (odds ratio [OR], 25.46; 95% confidence interval [CI], 7.09–91.42), the endoscopic resection was presumed incomplete (OR, 15.55; 95% CI, 4.28–56.56), or the lymph system was invaded (OR, 13.69; 95% CI, 1.76–106.57). Fourteen patients (6.2%) had residual or recurrent malignancies at the site of the previous ECC resection and were significantly associated with presumed incomplete endoscopic resection (OR, 4.59; 95% CI, 1.21–17.39) and submucosal invasion (OR, 5.14; 95% CI, 1.18–22.34). ConclusionsSubsequent surgery was associated with submucosa invasion, lymphatic invasion, and cancer-positive margins. Presumed completeness of the resection may be helpful for guiding the subsequent management of patients who undergo endoscopic resection of ECC.

Clinical outcomes of submucosal colorectal cancer diagnosed after endoscopic resection: a focus on the need for surgery

“…[14][15][16][17] Despite these various examination methods, it is not uncommon that lesions initially predicted as SSMC is ultimately diagnosed as DSMC and/or cancer with poor pathologic prognostic features after endoscopic resection thereby necessitating additional surgery. 18 Furthermore, it is also not uncommon that surgical specimens of DSMC and/or cancer with poor pathologic features show no regional lymph metastasis nor residual cancer thereby raising a question whether additional surgery would have been really necessary.…”

Emergence of a New Optical Marker for Colorectal Neoplasms: To What Extent Should We Accept It?

“…However, the actual diagnostic performance of type 2B is so weak that 37% and 12% of type 2B lesions were identified as low-grade dysplasia and deep submucosal invasive (SM-d) carcinoma, respectively [ 4 ]. The accurate prediction of histological findings through endoscopic examinations can enable the selection of the correct endoscopic resection method and reduce non-curative resection rates, thereby reducing unnecessary subsequent management efforts and the risk of poor outcomes such as recurrence [ 5 , 6 ].…”