Immunohistochemical alterations in invasive adenocarcinoma in endoscopically resected adenoma and factors associated with risk of residual or recurrent disease

Cubiella, Joaquín; Arias, M; Penín, Manuel; Quintas, Paola; Couto, Ignacio; Cobian, Carol; Bujanda, Luís; Fernández-Seara, Javier

doi:10.1111/j.1463-1318.2012.03051.x

Cited by 2 publications

(5 citation statements)

References 31 publications

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“…On the other hand, only complete en bloc resection makes possible to assess whether the surgical margins are disease free or not, and to measure the depth of the tumour invasion (6,10,18). In our series, we have previously found a statistically significant relationship between incomplete resection and the risk of residual disease or recurrence (12). These relationships highlight the need for using complex endoscopic techniques that achieve complete endoscopic resection in advanced adenomas.…”

Section: Discussionmentioning

confidence: 78%

“…It is nevertheless interesting to note that a recently published study found two factors to be associated with the risk of residual disease or recurrence: incomplete endoscopic resection and histological high-risk features (3,12). Currently, two types of criteria are used to determine the risk of recurrence: histological high risk features (3) and the extent of submucosal invasion (6,7,18).…”

Section: Discussionmentioning

confidence: 99%

“…In relation to this, we need accurate diagnostic criteria for assessing which cases of invasive adenocarcinoma arising in adenoma can be exclusively treated by endoscopic resection (2). A recently published retrospective study identifies factors that are independently associated with the risk of residual disease or recur- rence after endoscopic resection: histological high-risk features and incomplete endoscopic resection (12).…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with complete endoscopic resection of an invasive adenocarcinoma in a colorectal adenoma

Quintas

Cubiella

Couto

et al. 2012

Rev. esp. enferm. dig.

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Background and objective: endoscopic polypectomy may allow curative resection of invasive adenocarcinoma on colorectal adenoma. Our goal was to determine the factors associated with complete endoscopic resection of invasive adenocarcinoma.Methods: retrospective observational study. We included 151 patients with invasive adenocarcinoma on adenomas endoscopically resected between 1999 and 2009. We determined those variables independently related to incomplete resection by a logistic regression. Relation was expressed as Odds Ratio (OR) and its 95% confidence interval (95% CI).Results: patients were predominantly male (66.2%) and their mean age was 68.03 ± 10.65 years. Colonoscopy was complete in 84% of the patients and 60.3% had synchronous adenomas. Invasive adenocarcinoma was mainly located in distal colon (90.7%) and morphology was pedunculated in 75.5%. The endoscopic average size was 22.61 ± 10.86 mm. Submucosal injection was required in 32.5%. Finally, the resection was in one piece in 73.5% and incomplete in 8.6% of the adenocarcinomas. Factors independently associated with incomplete endoscopic resection were size (mm) (OR 1.08, 95% CI 1.03-1.14, p = 0.002), sessile or flat morphology (OR 8.78, p = 0.002) and incomplete colonoscopy (OR 4.73, p = 0.03).Conclusions: endoscopic polypectomy allows complete resection of 91.4% of invasive adenocarcinomas on colorrectal adenoma in our series. Factors associated with incomplete resection were the size of the lesion, sessile or flat morphology and incomplete colonoscopy.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors associated with complete endoscopic resection of an invasive adenocarcinoma in a colorectal adenoma

Quintas

Cubiella

Couto

et al. 2012

Rev. esp. enferm. dig.

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“…Instead, the risk for local recurrence was significantly higher in high-risk patients (incomplete resection, poor differentiation, vascular invasion, depth of submucosal invasion more than 1,000 µ) with submucosal rectal cancer than in patients with submucosal colon cancer when treated only with endoscopic resection. In another study the immunohistochemical expression pattern of several proteins in resected malignant polyps was also not associated with residual or recurrent disease (23). Thus there is a clear need for further evaluation in this area.…”

Section: Discussionmentioning

confidence: 99%

“…For more than 20 years investigators have searched for its determinants. The classical associated risk factors are depth (Sm3) submucosal invasion, poor differentiation, lymphovascular invasion, and tumor budding (20)(21)(22)(23). Radical oncologic surgery is recommended for patients with any of the previous factors (14).…”

Section: Discussionmentioning

confidence: 99%

Oncological outcomes after endoscopic removal of malignant colorectal polyps

Gonçalves

Fontainhas

Caetano

et al. 2013

Rev. esp. enferm. dig.

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Objective: malignant colorectal polyp, defined by submucosally invasive adenocarcinoma, is the earliest form of clinically relevant colorectal cancer (CRC). After endoscopic resection additional surgery may be necessary, although decision criteria remain debatable. The objective of this study was to assess oncologic outcomes in terms of locoregional disease and to identify areas of improvement that may facilitate patients' management.Methods: retrospective study of 40 patients with T1 CRC endoscopically resected between 2007 and 2012. Clinicopathological features were assessed and correlated with residual disease (RD), defined as presence of adenocarcinoma in intestinal wall and/ or lymph nodes.Results: thirty-one patients underwent surgery while 9 were followed-up. After surgery, RD was confirmed in 15 (48.4 %) patients: 8 (53.3 %) wall disease, 5 (33 %) nodal metastasis, and 2 (13.3 %) with both. No recurrence was detected in the follow-up group. The characteristics of the lesions that were associated with DR were sessile configuration (p = 0.03), the degree of differentiation G3 (p = 0.01) and intercepted/indeterminate margins (p = 0.01). Twenty-two patients were operated because of inadequate evaluation, mainly due to piecemeal resection, and half of them were disease free. Postoperative complications were found in 9 (30 %) patients, mainly anastomotic leakage that was associated with rectum anterior resection (p = 0.03).Conclusions: surgery should be considered in the presence of any risk factor for residual disease, while follow-up can be offered in low risk settings. Was also demonstrated a clear need for technical improvement in endoscopic resection and pathology evaluation in order to prevent unnecessary surgeries.

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Immunohistochemical alterations in invasive adenocarcinoma in endoscopically resected adenoma and factors associated with risk of residual or recurrent disease

Abstract: Immunohistochemistry could not predict residual or recurrent disease. Only incomplete excision and histological high risk did so. The factors independently associated were histological high-risk lesion and incomplete resection.

Cited by 2 publications

References 31 publications

Factors associated with complete endoscopic resection of an invasive adenocarcinoma in a colorectal adenoma

Factors associated with complete endoscopic resection of an invasive adenocarcinoma in a colorectal adenoma

Oncological outcomes after endoscopic removal of malignant colorectal polyps

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