Long-term outcomes after endoscopic versus surgical resection of T1 colorectal carcinoma

Bae, Hyun Jin; Ju, Hoyeon; Lee, Han Hee; Kim, Jinsu; Lee, Bo‐In; Lee, Sung Hak; Won, Dae; Lee, Yoon Suk; Lee, In Kyu; Cho, Young Seok

doi:10.1007/s00464-022-09649-1

Cited by 10 publications

(5 citation statements)

References 31 publications

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“…We identified 4,473 records from 5 electronic databases after removing duplicate records on April 14, 2023. After screening, we ultimately identified 42 studies with 41,290 patients ( 10 – 14 , 16 , 34 – 69 ).…”

Section: Resultsmentioning

confidence: 99%

“…However, the Japanese guidelines and College of American Pathologists Cancer Protocols classify differentiation according to the predominant grade ( 3 , 9 ). The approach to histological differentiation classification varies globally, with some institutions in Europe, South America, and Asia opting for the predominant differentiation classification, establishing that the concept is far from uniform across countries and institutions ( 10 – 16 ). For instance, if a resected tumor is composed of 95% well-differentiated and 5% poorly differentiated tissue, diagnoses of well-differentiated and poorly differentiated tumors would signify using predominant and highest-grade differentiation, respectively.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Accuracy of Highest-Grade or Predominant Histological Differentiation of T1 Colorectal Cancer in Predicting Lymph Node Metastasis: A Systematic Review and Meta-Analysis

Watanabe,

Ichimasa,

Kataoka

et al. 2024

Clin Transl Gastroenterol

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Introduction: Treatment guidelines for colorectal cancer (CRC) suggest two classifications for histological differentiation—highest-grade and predominant. However, the optimal predictor of lymph node metastasis (LNM) in T1 CRC remains unknown. This systematic review aimed to evaluate the impact of the use of highest-grade or predominant differentiation on LNM determination in T1 CRC. Methods: The study protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO, registration number: CRD42023416971) and was published in OSF (https://osf.io/TMAUN/) on April 13, 2023. We searched five electronic databases for studies assessing the diagnostic accuracy of highest-grade or predominant differentiation to determine LNM in T1 CRC. The outcomes were sensitivity and specificity. We simulated 100 T1 CRC cases, with an LNM incidence of 11.2%, to calculate the differences in false positives and negatives between the highest-grade and predominant differentiations using a bootstrap method. Results: In 42 studies involving 41,290 patients, the differentiation classification had a pooled sensitivity of 0.18 (95% confidence interval [CI], 0.13–0.24) and 0.06 (95% CI, 0.04–0.09) (P<0.0001) and specificity of 0.95 (95% CI, 0.93–0.96) and 0.98 (95% CI, 0.97–0.99) (P<0.0001) for the highest-grade and predominant differentiations, respectively. In the simulation, the differences in false positives and negatives between the highest-grade and predominant differentiations were 3.0% (range, 1.6–4.4) and −1.3% (range, −2.0 to −0.7), respectively. Conclusions: Highest-grade differentiation may reduce the risk of misclassifying LNM cases as negative, whereas predominant differentiation may prevent unnecessary surgeries. Further studies should examine differentiation classification using other predictive factors.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Highest-Grade or Predominant Histological Differentiation of T1 Colorectal Cancer in Predicting Lymph Node Metastasis: A Systematic Review and Meta-Analysis

Watanabe,

Ichimasa,

Kataoka

et al. 2024

Clin Transl Gastroenterol

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“…We identified 3451 records from various databases until December 10, 2022. After screening for duplicates, we included 64 studies with 18,097 patients, 17,18,22,36–96 of them, 59 studies evaluated the diagnostic accuracies of HE and additional staining for LVI in LNM in patients with T1 CRC, four reported the interobserver agreement among pathologists for positive LVI, and one reported both outcomes, with eight studies comprising 4062 patients in multivariable analysis.…”

Section: Resultsmentioning

confidence: 99%

“…The additional staining for VI did not show significant differences between EVG and VB staining among elastic staining. However, CD31 staining for VI did not have sufficient data for evaluation because it was often assessed in conjunction with elastic staining, 37,76,83 and only a few studies evaluated CD31 staining alone for VI. 38,42 In a previous study, CD31 staining was found to be less likely to detect VI than elastic staining and was not associated with prognosis.…”

Section: Discussionmentioning

confidence: 99%

Additional staining for lymphovascular invasion is associated with increased estimation of lymph node metastasis in patients with T1 colorectal cancer: Systematic review and meta‐analysis

Watanabe,

Ichimasa,

Kataoka

et al. 2023

Digestive Endoscopy

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ObjectivesLymphovascular invasion (LVI) is a critical risk factor for lymph node metastasis (LNM), which requires additional surgery after endoscopic resection of T1 colorectal cancer (CRC). However, the impact of additional staining on estimating LNM is unclear. This systematic review aimed to evaluate the impact of additional staining on determining LNM in T1 CRC.MethodsWe searched five electronic databases. Outcomes were diagnostic odds ratio (DOR), assessed using hierarchical summary receiver operating characteristic curves, and interobserver agreement among pathologists for positive LVI, assessed using Kappa coefficients (κ). We performed a subgroup analysis of studies that simultaneously included a multivariable analysis for other risk factors (deep submucosal invasion, poor differentiation, and tumor budding).ResultsAmong the 64 studies (18,097 patients) identified, hematoxylin‐eosin (HE) and additional staining for LVI had pooled sensitivities of 0.45 (95% confidence interval [CI], 0.32–0.58) and 0.68 (95% CI, 0.44–0.86), specificities of 0.88 (95% CI, 0.78–0.94) and 0.76 (95% CI, 0.62–0.86), and DORs of 6.26 (95% CI, 3.73–10.53) and 6.47 (95% CI, 3.40–12.32) for determining LNM, respectively. In multivariable analysis, the DOR of additional staining for LNM (DOR, 5.95; 95% CI, 2.87–12.33) was higher than that of HE staining (DOR, 1.89; 95% CI, 1.13–3.16) (p = 0.01). Pooled κ values were 0.37 (95% CI, 0.22–0.52) and 0.62 (95% CI, 0.04–0.99) for HE and additional staining for LVI, respectively.ConclusionsAdditional staining for LVI may increase the DOR for LNM and interobserver agreement for positive LVI among pathologists.

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“…[11] Furthermore, those without pathologically high-risk features (positive resection margin, deep submucosal invasion, poorly or mucinous carcinoma, lymph vascular invasion, and intermediate to high-grade budding) pose a risk of lymph node metastasis of <3% and comparable long-term outcomes to surgical resection. [11][12][13][14][15] Therefore, colorectal ESD has been used increasingly as a treatment modality for large colorectal lesions and early CRC. [16,17] However, colorectal ESD has a perforation risk of approximately 5%, higher than EMR.…”

Section: Introductionmentioning

confidence: 99%

Usage trends of colorectal endoscopic submucosal dissection according to hospital types based on nationwide claims data

Eun Na,

Kim,

Hoon Jung

et al. 2023

Medicine

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Although the use of colorectal endoscopic submucosal dissection (ESD) for colorectal lesions has increased, there is a lack of analysis of the recent usage trends of ESD. Thus, this study aimed to identify changes in the annual utilization of ESD and determine the proportion of surgeries after ESD according to hospital types. Using Health Insurance Review and Assessment data from 2012 to 2019, 26,502 colorectal ESD cases were analyzed to assess the annual usage trends of ESD according to hospital type, additional early and late surgeries after ESD, changes in the distribution of colorectal lesions, and factors associated with early and late surgery. Trend analysis was performed using the chi-squared test for trend in proportions. Colorectal ESD increased from 2046 in 2012 to 5319 in 2019. Additional early and late surgeries rose from 135 (6.6%) in 2012 to 441 (8.2%) in 2019 (P < .05) and from 9 (0.3%) in 2013 to 52 (1.0%) in 2019 (P < .05), respectively. In tertiary and general hospitals, the proportion of submucosal cancers decreased, whereas the proportion of intramucosal cancers increased. Submucosal cancer was associated with early (odds ratio: 108.90, 95% confidence interval: 61.67–192.35) and late surgery (odds ratio: 3.55, 95% confidence interval: 2.27–5.56). Using nationwide data, our study identified the clinical usage trends of colorectal ESD based on the annual increase in utilization and the proportion of additional surgeries after ESD.

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Long-term outcomes after endoscopic versus surgical resection of T1 colorectal carcinoma

Cited by 10 publications

References 31 publications

Diagnostic Accuracy of Highest-Grade or Predominant Histological Differentiation of T1 Colorectal Cancer in Predicting Lymph Node Metastasis: A Systematic Review and Meta-Analysis

Diagnostic Accuracy of Highest-Grade or Predominant Histological Differentiation of T1 Colorectal Cancer in Predicting Lymph Node Metastasis: A Systematic Review and Meta-Analysis

Additional staining for lymphovascular invasion is associated with increased estimation of lymph node metastasis in patients with T1 colorectal cancer: Systematic review and meta‐analysis

Usage trends of colorectal endoscopic submucosal dissection according to hospital types based on nationwide claims data

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