Should locally excised T1 rectal cancer receive adjuvant chemoradiation?

Lamont, Jeffrey P.; McCarty, Todd M.; Digan, Rick D; Jacobson, Robert M.; Tulanon, Paitoon; Lichliter, Warren E.

doi:10.1016/s0002-9610(00)00493-1

Cited by 54 publications

(61 citation statements)

References 21 publications

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“…The incidence of LNM in the submucosal invasive CRC has been reported to be approximately 7-15 %, and the treatment consists of endoscopic polypectomy, local excision for selected patients, or radical resection [12][13][14]. Many series in which long-term follow-up was performed have revealed that the local recurrence rate is high although submucosal invasive CRC can be expected to be treated by local excision without adjuvant therapy [9,10]. Therefore, some characters of primary tumor may determine the biological behavior of the tumor.…”

Section: Discussionmentioning

confidence: 99%

“…Knowledge of LVI will be helpful in differentiating the management modality after localized, nonmetastatic disease. There are several studies that report a high incidence of recurrence and LNM after a fullthickness local excision [9,10]. This prompted us to study the features of the primary tumors that may serve as risk factors for LVI in CRC.…”

Section: Introductionmentioning

confidence: 99%

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The Factors Effecting Lymphovascular Invasion in Adenocarcinoma of the Colon and Rectum

et al. 2013

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Adenocarcinomas of the colon and rectum are the most common gastrointestinal malignancy, and lymph node metastases are established as a prognostic factor. Lymphovascular invasion has been recognized as an indication of lymph node metastases. This prompted us to investigate the features of primary tumor that may serve as a risk factor for lymphovascular invasion in colorectal carcinoma. Clinical and pathologic tissue data of colorectal carcinoma treated in our hospital were retrieved from the computer files at Haydarpasa Numune Education and Research Hospital, from June 1998 to December 2010, retrospectively. We excluded all patients who have two-thirds distal rectal carcinoma to rule out neoadjuvant treatment bias. Tissues from the specimens were stained with standard hematoxylin and eosin. Clinical data including age and sex of patient, location and diameter of tumor, perineural invasion, peritumoral lymphocytic infiltration, tumor grade, lymphovascular invasion, Pathologic T level (pT), and lymph node metastasis were recorded. Lymphovascular invasion was present only in 43 patients out of 108. Only pT and lymph node metastases were found to be statistically significant related to lymphovascular invasion (p=0.04 and p<0.001). Perineural invasion, pT, and peritumoral lymphocytic infiltration are the factors with p<0.2 in the univariate analysis that were investigated with multivariate analysis, but no factor was found as an independent prognostic factor for lymphovascular invasion. Lymphovascular invasion is significantly related to lymph node metastases. Only pT is found as a factor that increases the lymphovascular invasion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Factors Effecting Lymphovascular Invasion in Adenocarcinoma of the Colon and Rectum

et al. 2013

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“…However, there is no scientific literature showing that it should be used at all stages of the disease 11 . Kath Because of the morbidity associated with this surgical procedure, now more conservative methods such as local resection associated with neoadjuvant or adjuvant treatment in selected cases of rectal tumors 8,14,16,30 are being used. Among the methods to local resection, the procedure is the standard TEM proposed by Buess in 1982 and introduced by Moraes in Brazil in 2002.…”

Section: Morbiditymentioning

confidence: 99%

“…Recent series from prospective studies suggest that the TEM associated with adjuvant treatment is a reasonable alternative to radical surgery in selected patients. The local resection alone is only acceptable treatment for tumors without adverse histopathological aspects, while the local resection with adjuvant therapy is an alternative for high-risk pT1 tumors 16 . Functional results of local treatment are generally good, morbidity and mortality after the surgery are acceptable.…”

Section: Morbiditymentioning

confidence: 99%

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Microcirurgia endoscópica transanal e tratamento adjuvante no câncer retal precoce

Moraes¹,

Losso²,

Matias³

et al. 2011

ABCD, arq. bras. cir. dig.

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-Background -The total mesorectal excision is considered the standard operation in the treatment of rectal tumors, although there is no scientific proof that it should be used for all stages of the disease. It has been demonstrated that in selected cases of rectal tumors, promising results can be achieved with local treatment by transanal endoscopic microsurgery. These tumors, called early rectal cancer, T1 tumors, are less than 4 cm, well differentiated without angiolymphatic invasion -pT1 SM1. As the risk of lymph node involvement in these tumors is approximately 3%, local resection would have a great chance to be curative. Aim -To present the results of a nonrandom prospective series of patients with early rectal cancer treated by transanal endoscopic microsurgery. Methods -Between 2002 and 2010, 38 patients evaluated by preoperative protocol as patients with early rectal cancer underwent endoscopic microsurgical resection of the entire rectal wall including the tumor when located between 2 and 8 cm from the dentate line. The preoperative evaluation consisted of digital rectal examination, rigid sigmoidoscopy macrobiopsies, barium enema and/or colonoscopy, endorectal ultrasound and abdominal computed tomography of the abdomen, chest radiography and serum CEA. Was conducted follow-up with endoscopy and endorectal ultrasound every three months during the first two years, and every six in the next three years, and CEA every six months during the same period of five years. Was evaluated the tumor recurrence, morbidity and mortality. Results -Pathologic evaluation considered 29 categorized as low risk and nine being high. The follow-up in the series ranged from one to seven years. Tumor recurrence was confirmed in two of the 38 cases (5.26%), in one the lesion was considered high and another low risk. Conclusion -Transanal endoscopic microsurgery associated or not to adjuvant therapy, may be, currently, considered the gold standard in local rectal resection, with encouraging results in cases chosen with early rectal tumors at low risk. ABCDDV/774RESUMO -Racional -A excisão total do mesorreto é considerada a operação padrão no tratamento dos tumores do reto, apesar de não existir comprovação científica de que ela deva ser usada para todos os estádios da doença. Tem sido demonstrado que em casos escolhidos de tumores retais, resultados promissores podem ser conseguidos com tratamento local por microcirurgia endoscópica transanal. Tais tumores, denominados de câncer retal precoce, são tumores T1 -menores do que 4 cm -, bem diferenciados sem invasão angiolinfática pT1 Sm1. Como o risco de comprometimento linfonodal nesses tumores é de aproximadamente 3%, a ressecção local teria grande chance de ser curativa. Objetivo -Apresentar os resultados de uma série prospectiva não randômica de pacientes portadores de câncer retal precoce submetidos ao tratamento local por microcirurgia endoscópica transanal. Métodos -Entre 2002 e 2010, 38 pacientes avaliados por protocolo pré-operatório como portadores câncer retal pre...

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Meta-analysis of oncological outcomes after local excision of pT1–2 rectal cancer requiring adjuvant (chemo)radiotherapy or completion surgery

Borstlap

Coeymans

Tanis

et al. 2016

British Journal of Surgery

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Should locally excised T1 rectal cancer receive adjuvant chemoradiation?

Cited by 54 publications

References 21 publications

The Factors Effecting Lymphovascular Invasion in Adenocarcinoma of the Colon and Rectum

The Factors Effecting Lymphovascular Invasion in Adenocarcinoma of the Colon and Rectum

Microcirurgia endoscópica transanal e tratamento adjuvante no câncer retal precoce

Meta-analysis of oncological outcomes after local excision of pT1–2 rectal cancer requiring adjuvant (chemo)radiotherapy or completion surgery

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