Pathological risk factors and predictive endoscopic factors for lymph node metastasis of T1 colorectal cancer: a single-center study of 846 lesions

Yasue, Chihiro; Chino, Akiko; Takamatsu, Manabu; Namikawa, Ken; Ichikawa, Daisuke; Saito, Shôichi; Igarashi, Masahiro; Fujisaki, Junko

doi:10.1007/s00535-019-01564-y

Cited by 87 publications

(111 citation statements)

References 33 publications

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“…Furthermore, eFTR enables safe and radical endoscopic resection of deep submucosal invasive cancer. Recent studies have reported a very low risk of LNM (1 % -2 %) in T1 CRC, with deep submucosal invasion as the only risk factor for LNM [26,27]. These findings underscore the need for clinical trials to assess the role of eFTR in T1 CRC treatment.…”

Section: Discussionmentioning

confidence: 91%

Endoscopic full-thickness resection (eFTR) of colorectal lesions: results from the Dutch colorectal eFTR registry

et al. 2020

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Background Endoscopic full-thickness resection (eFTR) is a minimally invasive resection technique that allows definite diagnosis and treatment for complex colorectal lesions ≤ 30 mm unsuitable for conventional endoscopic resection. This study reports clinical outcomes from the Dutch colorectal eFTR registry. Methods Consecutive patients undergoing eFTR in 20 hospitals were prospectively included. The primary outcome was technical success, defined as macroscopic complete en bloc resection. Secondary outcomes were: clinical success, defined as tumor-free resection margins (R0 resection); full-thickness resection rate; and adverse events. Results Between July 2015 and October 2018, 367 procedures were included. Indications were difficult polyps (non-lifting sign and/or difficult location; n = 133), primary resection of suspected T1 colorectal cancer (CRC; n = 71), re-resection after incomplete resection of T1 CRC (n = 150), and subepithelial tumors (n = 13). Technical success was achieved in 308 procedures (83.9 %). In 21 procedures (5.7 %), eFTR was not performed because the lesion could not be reached or retracted into the cap. In the remaining 346 procedures, R0 resection was achieved in 285 (82.4 %) and full-thickness resection in 288 (83.2 %). The median diameter of resected specimens was 23 mm. Overall adverse event rate was 9.3 % (n = 34/367): 10 patients (2.7 %) required emergency surgery for five delayed and two immediate perforations and three cases of appendicitis. Conclusion eFTR is an effective and relatively safe en bloc resection technique for complex colorectal lesions with the potential to avoid surgery. Further studies assessing the role of eFTR in early CRC treatment with long-term outcomes are needed.

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Section: Discussionmentioning

confidence: 91%

Endoscopic full-thickness resection (eFTR) of colorectal lesions: results from the Dutch colorectal eFTR registry

et al. 2020

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“…Moreover, deep submucosal infiltration was determined to be a histopathological risk factor. However, more recent evidence shows that deep submucosal invasion alone is not a strong risk factor for lymph node metastases in multivariable analysis 109 . Nevertheless, subgroup analysis for low-and high-risk pT1 tumours was undertaken because it provides important information for clinical decision-making, and reporting only overall local recurrence rates would have led to additional bias.…”

Section: Discussionmentioning

confidence: 98%

Local recurrence after local excision of early rectal cancer: a meta-analysis of completion TME, adjuvant (chemo)radiation, or no additional treatment

Oostendorp

Smits

Vroom

et al. 2020

British Journal of Surgery

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Background: The risks of local recurrence and treatment-related morbidity need to be balanced after local excision of early rectal cancer. The aim of this meta-analysis was to determine oncological outcomes after local excision of pT1-2 rectal cancer followed by no additional treatment (NAT), completion total mesorectal excision (cTME) or adjuvant (chemo)radiotherapy (aCRT). Methods: A systematic search was conducted in PubMed, Embase and the Cochrane Library. The primary outcome was local recurrence. Statistical analysis included calculation of the weighted average of proportions. Results: Some 73 studies comprising 4674 patients were included in the analysis. Sixty-two evaluated NAT, 13 cTME and 28 aCRT. The local recurrence rate for NAT among low-risk pT1 tumours was 6⋅7 (95 per cent c.i. 4⋅8 to 9⋅3) per cent. There were no local recurrences of low-risk pT1 tumours after cTME or aCRT. The local recurrence rate for high-risk pT1 tumours was 13⋅6 (8⋅0 to 22⋅0) per cent for local excision only, 4⋅1 (1⋅7 to 9⋅4) per cent for cTME and 3⋅9 (2⋅0 to 7⋅5) per cent for aCRT. Local recurrence rates for pT2 tumours were 28⋅9 (22⋅3 to 36⋅4) per cent with NAT, 4 (1 to 13) per cent after cTME and 14⋅7 (11⋅2 to 19⋅0) per cent after aCRT. Conclusion: There is a substantial risk of local recurrence in patients who receive no additional treatment after local excision, especially those with high-risk pT1 and pT2 rectal cancer. The lowest recurrence risk is provided by cTME; aCRT has outcomes comparable to those of cTME for high-risk pT1 tumours, but shows a higher risk for pT2 tumours.

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“…There have been various studies regarding the risk of LNM [22][23][24][25][26]. Lymphovascular invasion and histological grade are described in guidelines from the USA, Europe, and Japan [19,[27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Left-sided location is a risk factor for lymph node metastasis of T1 colorectal cancer: a single-center retrospective study

Mochizuki

Kudo

Ichimasa

et al. 2020

Int J Colorectal Dis

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Purpose Although some studies have reported differences in clinicopathological features between left- and right-sided advanced colorectal cancer (CRC), there are few reports regarding early-stage disease. In this study, we aimed to compare the clinicopathological features of left- and right-sided T1 CRC. Methods Subjects were 1142 cases with T1 CRC undergoing surgical or endoscopic resection between 2001 and 2018 at Showa University Northern Yokohama Hospital. Of these, 776 cases were left-sided (descending colon to rectum) and 366 cases were right-sided (cecum to transverse colon). We compared clinical (patients age, sex, tumor size, morphology, initial treatment) and pathological features (invasion depth, histological grade, lymphatic invasion, vascular invasion, tumor budding) including lymph node metastasis (LNM). Results Left-sided T1 CRC showed significantly higher rates of LNM (left-sided 12.0% vs. right-sided 5.4%, P < 0.05) and lymphatic invasion (left-sided 32.7% vs. right-sided 23.2%, P < 0.05). Especially, the sigmoid colon and rectum showed higher rates of LNM (12.4% and 12.1%, respectively) than other locations. Patients with left-sided T1 CRC were younger than those with right-sided T1 CRC (64.9 years ±11.5 years vs. 68.7 ± 11.6 years, P < 0.05), as well as significantly lower rates of poorly differentiated carcinoma/mucinous carcinoma than right-sided T1 CRC (11.6% vs. 16.1%, P < 0.05). Conclusion Left-sided T1 CRC, especially in the sigmoid colon and rectum, exhibited higher rates of LNM than right-sided T1 CRC, followed by higher rates of lymphatic invasion. These results suggest that tumor location should be considered in decisions regarding additional surgery after endoscopic resection. Trial registration This study was registered with the University Hospital Medical Network Clinical Trials Registry (UMIN 000032733).

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Pathological risk factors and predictive endoscopic factors for lymph node metastasis of T1 colorectal cancer: a single-center study of 846 lesions

Cited by 87 publications

References 33 publications

Endoscopic full-thickness resection (eFTR) of colorectal lesions: results from the Dutch colorectal eFTR registry

Endoscopic full-thickness resection (eFTR) of colorectal lesions: results from the Dutch colorectal eFTR registry

Local recurrence after local excision of early rectal cancer: a meta-analysis of completion TME, adjuvant (chemo)radiation, or no additional treatment

Left-sided location is a risk factor for lymph node metastasis of T1 colorectal cancer: a single-center retrospective study

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