Synchronous polypectomy during endoscopic diagnosis of colorectal cancer – is the risk of tumour implantation at the polypectomy site significant?

Tan, Winson Jianhong; Ng, Nick; Chen, Y. D.; Chee, Yinshan; Foo, Fung Joon; Tang, Choong Leong; Chew, Min Hoe

doi:10.1186/s12876-018-0861-4

Cited by 6 publications

(4 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nowadays, due to current diagnostic methods, preoperative surgical and therapeutic plans can be established to avoid complications and early recurrence of these tumors. A fundamental component for the diagnosis of colorectal cancer is a colonoscopy since it allows the identification of advanced polyps in up to 15–50% of cases [14] .…”

Section: Discussionmentioning

confidence: 99%

Left Perforated Colonic Tumor with Synchronous Locally Advanced Right Colonic Tumor

González

Villaseñor²,

Cruz

et al. 2022

Case Rep Gastroenterol

View full text Add to dashboard Cite

Colorectal cancer is one of the most common malignant neoplasms worldwide. Overall mortality is 33%. Synchronous colorectal cancer refers to more than one malignant tumor detected in different segments of the colon, simultaneously or within 6 months of initial diagnosis. The development of colorectal cancer is a multistep process that originates with a genetic mutation leading to a malignant phenotype and generating a growth advantage. Colorectal cancer presents up to 16% of hypermutations, of which 75% are characterized by microsatellite instability which in turn leads to poorer cell differentiation. Patients with synchronous tumors appear to have a higher proportion of microsatellite instability than patients with single tumors. The clinical case of a 35-year-old man with a perforated left colon tumor and a locally advanced synchronous tumor of the right colon and signs of acute abdomen is presented. The treatment should be based on the location of the synchronous tumors, stage at the time of approach, and the patient’s condition. However, when faced with a complication secondary to colonic cancer, adhering to the principles of oncological surgery can be overcome by the nature of the emergency.

show abstract

Section: Discussionmentioning

confidence: 99%

Left Perforated Colonic Tumor with Synchronous Locally Advanced Right Colonic Tumor

González

Villaseñor²,

Cruz

et al. 2022

Case Rep Gastroenterol

View full text Add to dashboard Cite

show abstract

“…The concern regarding implantation has also been considered for the removal of synchronous polyps at colonoscopy. However there is little evidence thus far to support implantation of malignant cells into the colon by removing multiple polyps (13). Another school of thought is that the spread may arise from micrometastasis left behind in the lymph nodes along the inferior mesenteric artery pedicle at the time of the APR.…”

Section: Discussionmentioning

confidence: 99%

Cutaneous Stomal Recurrence of Colorectal Cancer After Curative Rectal Cancer Surgery – A Case Report and Systematic Review

Davey

McCarthy

2020

In Vivo

View full text Add to dashboard Cite

Background/Aim: Stomal metastases from a primary rectal adenocarcinoma are rare, therefore, clear guidelines on treatment options are limited. We performed a systematic review including a case report on this subject with the primary objective of identifying the total number of cases in the literature. The secondary objective was to assess median survival. Materials and Methods: A 59-year-old woman presented to our institution with anal incontinence to mucus leakage. Flexible sigmoidoscopy identified a carpet adenoma from the dentate line to the rectosigmoid junction. An abdomino-perineal resection (APR) was performed using the transanal total mesorectal excision technique (TaTME). No adjuvant chemotherapy was offered. Twenty-one months following the operation a stomal recurrence was identified. Palliative radiotherapy was commenced and the patient is alive 6 months later with no visible recurrence at the site of the stoma. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Results: The systematic review identified 19 individual cases of either metachronous or true metastatic recurrence, including our own case. Median survival was 30 months in the 8 cases where further treatment was offered and accepted. Conclusion: Stomal metastases or metachronous colorectal cancer is uncommon. The causes for this pattern of spread are not clear. Long-term survival from cutaneous recurrence is generally poor. For carefully selected patients, redo surgery is an option with satisfactory results.

show abstract

“…It was estimated that 70% of patients with CRC were found to have viable, exfoliated malignant cells in the proximal and distal lumen adjacent to the tumor (2, 3). Exfoliated malignant cells were reported to implant on raw surfaces, such as polypectomy site (4)(5)(6), endoscopic biopsy site (7), wound of anal fissure (8), track of anal fistula (9)(10)(11), hemorrhoidectomy scar (1,12,13), perianal skin (14, 15), and hook insertion site of Lone Star retractors (16). Implanted metastasis had also been reported in colorectal stapled suture line (17), and it may lead to anastomotic recurrence (18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

“…No study yet provided strong evidence to clarify the origin of metastasis from the molecular point. In theory, genomic analysis and comparative study of the original and anastomotic tumor could help us demonstrate true implantation metastasis ( 5 , 22 ). This study aims to differentiate implantation metastasis from metachronous carcinogenesis with whole exome sequencing (WES) and Lineage Inference for Cancer Heterogeneity and Evolution (LICHeE) analysis.…”

Section: Introductionmentioning

confidence: 99%

Implantation metastasis from sigmoid colon cancer to rectal anastomosis proved by whole exome sequencing and lineage inference for cancer heterogeneity and evolution analysis: Case report and literature review

Xian²,

Xia³

et al. 2022

Front. Oncol.

View full text Add to dashboard Cite

It was estimated that 70% of patients with colorectal cancer were found to have viable exfoliated malignant cells in adjacent intestinal lumen. Exfoliated malignant cells had been reported to implant on raw surfaces, such as polypectomy site, anal fissure, anal fistula, hemorrhoidectomy wound, and anastomotic suture line. Tumors at anastomosis could be classified into four groups: local recurrence, local manifestation of widespread metastasis, metachronous carcinogenesis, and implantation metastasis. However, all of the previous studies only reported the phenomena of implantation metastasis at anastomosis. No study had proved the origin of anastomotic metastasis by genomic analysis. In this study, a 43-year-old woman presented with persistent hematochezia was diagnosed as having severe mixed hemorrhoids. She was treated by procedure for prolapse and hemorrhoids (PPH), without receiving preoperative colonoscopy. Two months later, she was found to have sigmoid colon cancer by colonoscopy due to continuous hematochezia and received radical sigmoidectomy. Postoperative histological examination confirmed the lesion to be a moderately differentiated adenocarcinoma (pT3N1M0). Six months later, she presented with hematochezia again and colonoscopy revealed two tumors at the rectal anastomosis of PPH. Both tumors were confirmed to be moderately differentiated adenocarcinoma without lymph node and distant metastasis and were finally removed by transanal endoscopic microsurgery (TEM). Pathological examination, whole exome sequencing (WES), and Lineage Inference for Cancer Heterogeneity and Evolution (LICHeE) analysis demonstrated that the two tumors at the rectal anastomosis were probably implantation metastases arising from the previous sigmoid colon cancer. This is the first study to prove implantation metastasis from colon cancer to a distal anastomosis by WES and LICHeE analysis. Therefore, it is recommended to rule out colorectal cancer in proximal large bowel before performing surgery with a rectal anastomosis, such as PPH and anterior resection. For patients with a suspected implanted tumor, WES and LICHeE could be used to differentiate implantation metastasis from metachronous carcinogenesis.

show abstract

Synchronous polypectomy during endoscopic diagnosis of colorectal cancer – is the risk of tumour implantation at the polypectomy site significant?

Cited by 6 publications

References 17 publications

Left Perforated Colonic Tumor with Synchronous Locally Advanced Right Colonic Tumor

Left Perforated Colonic Tumor with Synchronous Locally Advanced Right Colonic Tumor

Cutaneous Stomal Recurrence of Colorectal Cancer After Curative Rectal Cancer Surgery – A Case Report and Systematic Review

Implantation metastasis from sigmoid colon cancer to rectal anastomosis proved by whole exome sequencing and lineage inference for cancer heterogeneity and evolution analysis: Case report and literature review

Contact Info

Product

Resources

About