Endoscopically removed malignant colorectal polyps: Clinicopathologic correlations

Cooper, Harry S.; Deppisch, Ludwig M.; Gourley, William K.; Kahn, Ellen; Lev, Robert; Manley, Paul; Pascal, Robert; Qizilbash, Ali H.; Rickert, Robert R.; Silverman, Jan F.; Wirman, John A.

doi:10.1016/0016-5085(95)90126-4

Cited by 258 publications

(266 citation statements)

References 20 publications

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“…These observations clearly suggest that after endoscopic polypectomy all three risk factors need to be simultaneously evaluated by the pathologist and that the classification of patients in low-risk and high-risk groups is clinically meaningful. A second relevant finding is to have definitely shown that low-risk and high-risk polyps do not only differ in lymphnodal disease rate, as previously reported, 19 but also for distant metastasis and mortality rates. Such worse clinical outcome occurred despite the majority of the highrisk patients underwent surgical resection.…”

Section: Discussionsupporting

confidence: 52%

“…In 23 series, [14][15][16][17][18][19][20][21][22][24][25][26][27]29,[31][32][33][34][35]38,[40][41][42] clinical or endoscopic follow-up data were available, ranging from 12 to 90 (median, 60) months, and accounting for 1,535 (80.1 percent) of the included polyps. Regarding endoscopic data, polyp site was clearly specified in 17 series, accounting for 1,461 polyps.…”

Section: Descriptive Analysismentioning

confidence: 99%

“…Death because of surgical complications, inferred from 28 studies, was reported in 8 (0.8 percent) of 951 operated patients. [12][13][14][15][16][17][18][19][20][21][24][25][26][27][28][29][30][31][32][33][34][36][37][38][39][40][41][42] …”

Section: Descriptive Analysismentioning

confidence: 99%

“…[12][13][14][16][17][18][19]21,[27][28][29][30][31][32][33][34]37,[40][41][42] According to our protocol, the resection margin was reported to be positive in 325 (33.2 percent) and negative in the remaining 655 (66.8 percent) cases. In those studies for which polyp morphology also could be inferred, a positive resection margin was significantly more frequent in sessile (25/44) than in pedunculated (34/182) polyps (56.8 vs. 18.7 percent; P < 0.0001).…”

Section: Resection Marginmentioning

confidence: 99%

“…[12][13][14]16,[18][19][20][21][22][23]25,26,[28][29][30][31]33,35,39,[40][41][42] This risk factor tended to be more frequent in sessile (30/214) compared with pedunculated (30/327) polyps (14 vs. 9.2 percent, respectively; P = 0.08). 12,20,21,26,28,33,35 Lymph node metastasis was much more common in polyps with such a risk factor than in those without it, whereas no substantial difference in residual disease, hematogenous metastasis, or cancer-related mortality was detected (Table 1).…”

Section: Vascular Invasionmentioning

confidence: 99%

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Histologic Risk Factors and Clinical Outcome in Colorectal Malignant Polyp: A Pooled-Data Analysis

Hassan

Zullo

Risio

et al. 2005

Diseases of the Colon &Amp; Rectum

195

186

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PURPOSE:The malignant polyp carries a significant risk of lymphohematic metastasis and mortality. Clinical usefulness of histologic risk factors is still controversial. The study was designed to compute the association between the main histologic risk factors and the occurrence of unfavorable outcomes in patients with malignant polyps. METHODS: A MEDLINE search regarding malignant polyps was performed. Three histologic risk factors (positive resection margin, poor differentiation of carcinoma, vascular invasion) and five (residual disease, recurrent disease, lymph node metastasis, hematogenous metastasis, mortality) unfavorable clinical outcomes were evaluated. Further analysis was performed by subgrouping polyps in high-risk and lowrisk groups. RESULTS: Thirty-one studies enrolling 1,900 patients with malignant polyp were selected. Positivity of resection margin was significantly predictive of the presence of residual disease (odds ratio, 22; P < 0.0001), poorly differentiated carcinoma was associated with an increased mortality (odds ratio, 9.2; P < 0.05), and vascular invasion with a higher lymph node metastasis risk (odds ratio, 7; P < 0.05). Patients with high-risk polyps showed a significantly worse outcome than those with low-risk, especially for mortality (odds ratio, 11; P < 0.05). Surgical-related death was as low as 0.8 percent. CONCLUSIONS: All three histologic risk factors are significantly associated with the clinical outcome. Classification in low-risk and high-risk patients may be regarded as a meaningful staging procedure. T he malignant polyp, namely an adenoma containing a carcinoma invading the submucosa but not the muscular layer, represents the vast majority of early colorectal cancer, carrying a small but significant risk of both lymphohematic metastasis and mortality. 1

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Section: Discussionsupporting

confidence: 52%

Section: Descriptive Analysismentioning

confidence: 99%

Section: Descriptive Analysismentioning

confidence: 99%

Section: Resection Marginmentioning

confidence: 99%

Section: Vascular Invasionmentioning

confidence: 99%

See 3 more Smart Citations

Histologic Risk Factors and Clinical Outcome in Colorectal Malignant Polyp: A Pooled-Data Analysis

Hassan

Zullo

Risio

et al. 2005

Diseases of the Colon &Amp; Rectum

195

186

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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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