Re-examining the 1-mm margin and submucosal depth of invasion: a review of 216 malignant colorectal polyps

Berg, Kyra B.; Telford, Jennifer J.; Gentile, Laura; Schaeffer, David F.

doi:10.1007/s00428-019-02711-9

Cited by 17 publications

(34 citation statements)

References 24 publications

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“…The risk of recurrence is estimated in the literature between 0.8–48.4% [ 31 , 33 , 34 , 39 , 42 , 43 , 44 , 45 ] and is related to several factors, such as type of polyp, resection border, depth of invasion, grading, lymphovascular invasion and budding. The risk is lower after EBR, in polyps with border margin above 1–2 mm (although even a 0.1 mm margin is safe in some studies) [ 19 , 43 , 46 ], in pedunculated lesions (0.8–10%) [ 7 , 30 ] and in endoscopic vs surgical group [ 39 ]. The risk is higher for PMR (12–14%) vs ESD (2%) [ 10 ] and a recurrence of benign adenoma component was also noted for PMR [ 47 ].…”

Section: ⧉ Discussionmentioning

confidence: 99%

“…The rate of nodal involvement in several studies was between 6.2% and 8.6% [ 37 , 42 , 48 , 49 ]. The risk of nodal invasion is correlated with several factors, such as greater width and depth invasion [ 31 , 35 ], invasion of basis of the stalk or of basis of sessile polyps (12–25%) [ 34 ], G3 [ 46 ], and grade 2/3 of tumoral budding [ 22 ], pathological incomplete removal, lymphatic invasion (OR 9.2, p =0.02) [ 42 ] and vascular invasion (OR 7 for colon and OR 12 for rectal location) [ 18 ]. Nodal metastasis was more frequent in rectum (15%) compared with left (8%) or right location (3%) [ 34 ].…”

Section: ⧉ Discussionmentioning

confidence: 99%

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Factors predicting occurrence and therapeutic choice in malignant colorectal polyps: a study of 13 years of colonoscopic polypectomy

Cazacu

Săftoiu²,

Iordache³

et al. 2022

Rom J Morphol Embryol

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Colorectal carcinoma represents a major cause of mortality and 0.2–12% of resected colonic polyps have malignant cells inside. We performed a retrospective study of patients with resected polyps during a period of 13 years. A total of 905 patients had 2033 polyps removed; 122 polyps (109 patients) had malignant cells. Prevalence of malignant polyps with submucosal invasion was 1.23% and for all polyps with malignant cells was 6%; malignant polyps had a larger size (23.44 mm mean diameter) vs benign polyps (9.63 mm); the risk of malignancy was increased in polyps larger than 10 mm, in lateral spreading lesions and in Paris types 0-Ip, 0-Isp, in sigmoid, descending colon and rectum, in sessile serrated adenoma and traditional serrate adenoma subtypes of serrated lesions and in tubulovillous and villous adenoma. In 18 cases surgery was performed, in 62 patients only colonoscopic follow-up was made and in 35 patients no colonoscopic follow-up was recorded. From initially endoscopic resected polyps, recurrence was noted in seven (11.3%) cases; there was a trend toward association with depth of invasion, piecemeal resection, right and rectum location, sessile and lateral spreading type and pathological subtype. In surgical group, post-therapeutic staging was available in 11 cases; nodal involvement was noted in three (27.27%) cases; none had lymphatic or vascular invasion in endoscopically resected polyps. Four patients with no macroscopic local recurrence underwent surgery with no residual tumor. The rate of metastasis was 16.67% in surgical group and 1.61% in endoscopic group. Evaluation of lymph node (LN) invasion was available for 11 operated patients, with LN invasion (N1) in three patients, local residual tumoral tissue in one patient with incomplete resection and no residual tumor (R0 resection) in four patients with endoscopic resection before surgery.

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Section: ⧉ Discussionmentioning

confidence: 99%

Section: ⧉ Discussionmentioning

confidence: 99%

Factors predicting occurrence and therapeutic choice in malignant colorectal polyps: a study of 13 years of colonoscopic polypectomy

Cazacu

Săftoiu²,

Iordache³

et al. 2022

Rom J Morphol Embryol

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“…The definition of a positive margin varies in the literature, ranging from tumor at cautery to a less than 2 mm margin [ 4 , 9 , 40 ]. Traditionally, the cutoff for a positive margin was set at 2 mm.…”

Section: Introductionmentioning

confidence: 99%

“…In fact, Brown et al [ 39 ] showed that none of the MP with a margin between 0.1 and 1 mm had residual carcinoma in the resected surgical specimens. Berg et al [ 40 ] showed, in their cohort, that the presence of tumor at the cautery line carries a significantly higher risk of lymph node metastases when compared to a margin of greater than 0 mm, which had no risk of residual carcinoma and minimal risk of LNM.…”

Section: Introductionmentioning

confidence: 99%

“…This potential change in the positive margin cutoff would have a significant impact on the number of patients requiring surgery, since, in the absence of other histopathological risk features, surgery would only be performed when tumor is present at the margin of resection [ 40 ]. Brown et al further proposed that cases with positive margins might also be managed by additional local resection instead of surgery, in the absence of other risk factors [ 39 ]; this is also advocated by other authors [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Colorectal malignant polyps: a modern approach

Saraiva¹

2021

aog

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Colorectal malignant polyps (MP) are polyps with invasive cancer into the submucosa harboring a variable risk of lymph node involvement, which can be estimated through evaluation of morphological, endoscopic, and histologic features. The recent advances in imaging endoscopic techniques have led to the possibility of performing an optical diagnosis of T1 colorectal cancer, allowing the selection of the best therapeutic modality to optimize outcomes for the patient. When MP are diagnosed after endoscopic removal, their management can be challenging. Differentiating low- and high-risk histologic features that influence the possibility of residual tumor, the risk of recurrence and the risk of lymph node metastasis, is crucial to further optimize treatment and surveillance plans. While the presence of high-risk features indicates a need for surgery in the majority of cases, location, comorbidities and the patient’s preference should be taken in account when making the final decision. This is a particularly important issue in the management of low rectal MP presenting with high-risk features, where chemoradiotherapy followed by a watch-and-wait strategy has demonstrated promising results. In this review we discuss the important prognostic features of MP and the most modern approaches regarding their management.

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Sporadic Polyps of the Colorectum

Brown,

Bettington

2024

Gastroenterology Clinics of North America

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Re-examining the 1-mm margin and submucosal depth of invasion: a review of 216 malignant colorectal polyps

Cited by 17 publications

References 24 publications

Factors predicting occurrence and therapeutic choice in malignant colorectal polyps: a study of 13 years of colonoscopic polypectomy

Factors predicting occurrence and therapeutic choice in malignant colorectal polyps: a study of 13 years of colonoscopic polypectomy

Colorectal malignant polyps: a modern approach

Sporadic Polyps of the Colorectum

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