Endoscopic treatment of submucosal invasive colorectal carcinoma with special reference to risk factors for lymph node metastasis

Tanaka, Shinji; Haruma, Ken; Teixeira, Carlos Roberto; Tatsuta, Shigehiko; N, Ohtsu; Hiraga, Yoshikazu; Yoshihara, Masaharu; Sumii, Koji; Kajiyama, Goro; Shimamoto, Fumio

doi:10.1007/bf02349636

Cited by 163 publications

(127 citation statements)

References 25 publications

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“…According to previous reports, moderately or poorly differentiated adenocarcinoma 3,7,12,13 , and a bud-like structure 9 in submucosal invasive areas are risk factors for lymph node metastasis. Although our data trends were similar, these factors did not show statistical significance in our study.…”

Section: Discussionmentioning

confidence: 94%

“…Although our data trends were similar, these factors did not show statistical significance in our study. Moreover, many investigators [3][4][5][6][7][8][9][10][11][12][13][14][15] list mucinous adenocarcinoma as a Risk of metastasis of submucosal colon cancer Y Egashira et al risk factor for lymph node metastasis. In this study, mucinous adenocarcinoma was considered as two types, one composed of undifferentiated nontubular carcinoma (signet ring cell carcinoma in the majority) and one composed of differentiated tubular adenocarcinoma.…”

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%

“…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: 94%

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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“…Therefore, the number of cases of ER for early colorectal carcinoma has increased. However, reviews of the literature showed that lymph node metastasis occurred in approximately 10% of the patients with submucosal invasive colorectal carcinoma (Tanaka et al 1995;Suzuki et al 2003). Lymph node metastasis is one of the most important prognostic factors in colorectal carcinoma (Eisenberg et al 1982;Gennari et al 2000).…”

mentioning

confidence: 99%

Prognostic and Diagnostic Significance of Tumor Budding Associated with β-Catenin Expression in Submucosal Invasive Colorectal Carcinoma

Umemura

Takagi

Shimada

et al. 2013

Tohoku J. Exp. Med.

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Endoscopic resection has become a major curative treatment for early colorectal carcinoma without lymph node metastasis. However, lymph node metastasis, a poor prognostic factor in colorectal carcinoma, occurs in about 10% of the patients with submucosal invasive colorectal carcinoma. Therefore, it is important to identify a high-risk factor for lymph node metastasis in submucosal invasive colorectal carcinoma. This study was designed to identify the relationship between tumor budding with β-catenin expression and lymph node metastasis in submucosal invasive colorectal carcinoma. We investigated the immunohistochemistry of tumor budding in the 142 patients who underwent surgical resection for submucosal invasive colorectal carcinomas between 1984 and 1999 and the expression pattern of β-catenin in budding tumor cells. Accordingly, all the patients were followed up for at least 10 years or until death. Among the 142 patients, lymph node metastasis was detected in 14 patients (9.9%). Univariate analysis showed that tumor budding with ≥ 5 tumor cells or cell clusters with expression of β-catenin in the nucleus was significantly associated with lymph node metastasis (P = 0.005). In contrast, tumor budding detected by hematoxylin and eosin staining was not associated with lymph node metastasis. Multivariate logistic regression analysis showed that tumor budding with ≥ 5 tumor cells or cell clusters with expression of β-catenin in the nucleus was a significant risk factor for lymph node metastasis (odds ratio, 7.124; 95% confidence interval, 1.407-36.062). Thus, tumor budding associated with β-catenin expression is a risk factor for lymph node metastasis in submucosal invasive colorectal carcinoma.

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Determining the Need for Radical Surgery in Patients With T1 Rectal Cancer

Salinas

Dursun²,

Klos³

et al. 2011

Arch Surg

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In the era of modern preoperative staging of patients with rectal cancer, lymph node metastases can be reliably predicted by the histological features of the tumor and preoperative imaging. Local resection can then be safely offered to the patients who are at low risk of having malignant lymph nodes. Design:We reviewed the records of 109 consecutive patients with preoperative imaging results suggestive of T1N0 or T2N0 disease who underwent total mesorectal excision. All patients underwent preoperative endorectal ultrasonography or magnetic resonance imaging and computed tomography, with or without positron emission tomography. Final pathologic investigation identified T3 disease in 27 patients. History, physical examination results, and radiologic and pathologic data were evaluated for predictors of positive nodes in the remaining 82 patients.Setting: Tertiary care referral center.Patients: Patients with preoperative imaging suggestive of T1N0 or T2N0 rectal cancer. Main Outcome Measures:To evaluate different clinical and pathologic tumor features as predictors of positive lymph nodes in T1 and T2 rectal cancers with negative radiographic nodes.Background: Local resection of T1 and T2 rectal cancer results in lower morbidity compared with radical resection. However, recurrence rates after local resection are higher, likely owing to unresected nodal metastasis. Reports on predictors of lymph node metastasis remain inconsistent in the literature. Although local resection may be appropriate for some rectal cancers, selection criteria remain unclear.

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Endoscopic treatment of submucosal invasive colorectal carcinoma with special reference to risk factors for lymph node metastasis

Cited by 163 publications

References 25 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

Prognostic and Diagnostic Significance of Tumor Budding Associated with β-Catenin Expression in Submucosal Invasive Colorectal Carcinoma

Determining the Need for Radical Surgery in Patients With T1 Rectal Cancer

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