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

Abstract

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.

Early Colon Cancer Recurring as Liver Metastasis without Local Recurrence Three Years after Complete Endoscopic Mucosal Resection

“…On the other hand, Kimura et al [14] have stated that “head invasion” itself is not a metastasis-free condition. Of 76 patients who had a malignant pedunculated colorectal polyp, lymph node metastasis rate was 13.3% (4/30) for head invasion and 10.9% (5/46) for stalk invasion.…”

Histologic Factors Associated With Need for Surgery in Patients With Pedunculated T1 Colorectal Carcinomas

“…5,13 Instead, we evaluated the Haggitt classification, and confirmed previous studies that this factor per se is insufficient for risk stratification. 7,13,41 For an adequate assessment, it is essential that both the endoscopist and pathologist handle the polyp in such a way that accurate information concerning the level of invasion can be obtained, as emphasized by Haggitt et al 12 If malignancy is suspected, the stalk should be snared at the base so that the pathologist can distinguish Haggitt 3 from Haggitt 4 invasion.…”

Clinicopathological features of T1 colorectal carcinomas with skip lymphovascular invasion

“…With recent advances in endoscopic treatments, such as ESD, many T1 CRCs can be resected endoscopically with negative margin. Although endoscopic treatment is an attractive option for the patients, T1 CRCs show approximately 10% of LNM, which requires surgical colectomy with lymph node dissection to cure the cancer (13)(14)(15)(16)(17)(18)(19)(20). Therefore, it is important to reveal the risk factors for LNM in the patients with T1 CRCs, and we should decide whether additional surgery after endoscopic resection is needed according to the presence of risk factors for LNM.…”