Factors Associated With Risk for Colorectal Cancer Recurrence After Endoscopic Resection of T1 Tumors

Yoshii, Shinji; Nojima, Masanori; Nosho, Katsuhiko; Omori, Saori; Kusumi, Takaya; Okuda, Hiroyuki; Tsukagoshi, Hiroyuki; Fujita, Masahiro; Yamamoto, Hiroyuki; Hosokawa, Masao

doi:10.1016/j.cgh.2013.08.008

Cited by 146 publications

(128 citation statements)

References 28 publications

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“…On the other hand, the local and/or metastatic recurrence rate after endoscopic resection of T1 CRC was reported to be very low (0-2.3%) in the absence of risk factors for LN metastasis other than submucosal invasion depth [16,18,19,27]. Subsequent surgery is therefore not likely to be absolutely essential in all of these T1 CRC patients.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, in another study, we suggested the condition of the muscularis mucosae to be an indicator for LN metastasis in T1 CRC [17]. The conditions under which the risk of LN metastasis of T1 CRC is extremely low are becoming clearer by stratifying these risk factors [16,17,18,19]. Based on these conditions, it is suggested that ESD as total excisional biopsy for T1 CRC will become increasingly more important in the near future.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic Submucosal Dissection as Total Excisional Biopsy for Clinical T1 Colorectal Carcinoma

et al. 2015

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Background/Aims: Only the depth of submucosal invasion can be estimated prior to determining the indications for endoscopic submucosal dissection (ESD) as a curative treatment for colorectal carcinoma (CRC). Here we evaluated the outcomes of ESD for clinical T1 CRCs. Methods: Of 660 patients who underwent ESD for CRC at the Hiroshima University Hospital between June 2003 and December 2013, we examined the outcomes of 37 (6%; 26 men, 11 women; mean age ± SD, 68 ± 12 years) who underwent ESD as total excisional biopsy for various reasons, in spite of an endoscopic diagnosis of T1 CRC. Results: The mean lesion size was 25 ± 14 mm; 14 lesions were protruding and 23 were superficial. The en bloc resection rate was 100% (37/37). The histological en bloc resection rate was 92% (34/37). ESD resulted in a positive vertical margin in 3 cases. Deep submucosal invasion was seen in 3 cases, 2 of which had severe submucosal fibrosis. Although severe submucosal fibrosis was not found in other cases, pathologic examination of the deepest invasive portion of the tumor revealed poorly differentiated adenocarcinoma. The rates of post-ESD bleeding and perforation were 8% (3/37) and 5% (2/37), respectively. All patients recovered under conservative therapy. No cases of recurrence were noted in patients without additional surgical resection when the lesions satisfied the curative conditions listed in the 2014 Japanese Society for Cancer of the Colon and Rectum guidelines. Conclusion: En bloc resection by ESD as total excisional biopsy for clinical T1 CRC is a highly effective treatment and establishes a precise histological diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endoscopic Submucosal Dissection as Total Excisional Biopsy for Clinical T1 Colorectal Carcinoma

et al. 2015

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“…This concept is supported by the investigation, including prognosis by Asayama et al [24] . Regarding T1CC in nonpedunculated lesions, some investigators reported that the degree of submucosal invasion was not an important risk factor for LNM because of several practical problems, and that additional surgery should be considered based on the pathological factors [35,36] . The results of our study were similar: all the 4 cases of head invasion with LNM had at least one of the following factors: lymphovascular infiltration, tumor budding, or a Por/Muc component.…”

Section: Discussionmentioning

confidence: 99%

‘Head Invasion' Is Not a Metastasis-Free Condition in Pedunculated T1 Colorectal Carcinomas Based on the Precise Histopathological Assessment

Kimura

Kudo²,

Miyachi³

et al. 2016

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Background/Aim: Previous reports stated that pedunculated T1 colorectal carcinomas with ‘head invasion' showed almost no nodal metastasis, requiring endoscopic treatment alone. However, clinically, some lesions develop nodal metastasis. We aimed to validate the necessity of distinguishing between ‘pedunculated' and ‘non-pedunculated' lesions, and also between ‘head' and ‘stalk' invasions. Methods: Initial or additional surgery with lymph node dissection was performed in 76 pedunculated and 594 non-pedunculated cases. Among pedunculated lesions, the baseline was defined as the junction line between normal and neoplastic epithelium (Haggitt's level 2). The degree of invasion was classified as ‘head invasion' (above the baseline) or ‘stalk invasion' (beyond the baseline). Clinicopathological factors were analyzed with respect to nodal metastasis. Results: Nine of 76 (11.8%) pedunculated cases and 52/594 (8.8%) non-pedunculated cases developed nodal metastasis (p = 0.40). No significant differences were found in the rate of nodal metastasis between ‘head invasion' (4/30, 13.3%) and ‘stalk invasion' (5/46, 10.9%). All the 4 cases with ‘head invasion' had at least one pathological factor. Conclusions: ‘Head invasion' was not a metastasis-free condition. Even for pedunculated T1 cancers with ‘head invasion', additional surgery with lymph node dissection should be considered if these have pathological risk factors.

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“…On the basis of another retrospective study of patients who underwent endoscopic resection for T1 CRC, those with tumors with only submucosal invasion were at low risk for cancer recurrence. However, patients with high-risk tumor features have greater risks for cancer recurrence and benefit from subsequent surgery (5).…”

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confidence: 99%

Incomplete resection after macroscopic radical endoscopic resection of T1 colorectal cancer—should a paradigm-changing approach to address the risk be considered?

Leung

2017

Transl. Gastroenterol. Hepatol.

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Factors Associated With Risk for Colorectal Cancer Recurrence After Endoscopic Resection of T1 Tumors

Cited by 146 publications

References 28 publications

Endoscopic Submucosal Dissection as Total Excisional Biopsy for Clinical T1 Colorectal Carcinoma

Endoscopic Submucosal Dissection as Total Excisional Biopsy for Clinical T1 Colorectal Carcinoma

‘Head Invasion' Is Not a Metastasis-Free Condition in Pedunculated T1 Colorectal Carcinomas Based on the Precise Histopathological Assessment

Incomplete resection after macroscopic radical endoscopic resection of T1 colorectal cancer—should a paradigm-changing approach to address the risk be considered?

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