The Subserosal Elastic Lamina: An Anatomic Landmark for Stratifying pT3 Colorectal Cancer

Shinto, Eiji; Ueno, Hideki; Hashiguchi, Yojiro; Hase, Kazuo; Tsuda, Hitoshi; Matsubara, Osamu; Mochizuki, Hidetaka

doi:10.1007/s10350-003-0083-9

Cited by 38 publications

(46 citation statements)

References 16 publications

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“…Additionally, only 28% of cases showed strong and continuous staining of the elastic lamina. In contrast, three other studies have shown that survival was significantly shorter in those with elastic lamina invasion than those without invasion, 13,15,16 and two of these reported survival in some subsets of cases more similar to T4 lesions than T3 without elastic lamina invasion. However, in Liang's study, the elastic lamina was only evaluable in 41% of cases.…”

Section: Elastic Stain To Identify Elastic Lamina Invasionmentioning

confidence: 84%

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Serosal surfaces, mucin pools, and deposits, Oh my: challenges in staging colorectal carcinoma

Frankel

Jin

2015

Modern Pathology

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Colorectal carcinoma is the third most common cancer in the United States. Proper and standardized pathologic staging is vital for prognostic assessment and impacts therapeutic decisions. The Tumor Node Metastasis (TNM) staging system was developed by the American Joint Committee on Cancer (AJCC) to be a data-driven, evidence-based staging system providing an accurate prediction of outcome. The AJCC 7th edition (2010) included several changes clarifying some issues and leading to new controversies. We aim to address selected challenging issues in tumor T staging, neoadjuvant treatment effects in rectal cancer, and definition of lymph node vs tumor deposit. Serosal involvement in colorectal cancer is staged as T4, which is associated with decreased survival and may impact additional therapy decisions. Although careful sampling and sectioning are helpful, challenges remain in interpretation of tumor within 1 mm of serosal surface with a reaction. Elastic stain as a surrogate marker for serosal invasion has been studied, but its usefulness remains unclear. Some unique issues in rectal cancer include the presence of serosa in proximal but not in distal tumors and post-neoadjuvant effects. Tumor should be staged based on tumor cells rather than acellular mucin pools. Additionally, tumor response should be graded only in primary tumor but not in lymph nodes or metastatic sites. The distinction between tumor deposits and lymph nodes has been modified in AJCC TNM from using size in the 5th edition, to the round contour in the 6th edition, to only features of residual lymph node architecture in the 7th edition. Interobserver variability remains but tumor deposits should be documented when present. The number of deposits should not be added to the total number of positive lymph nodes, and the N1c designation should only be used in cases without any positive lymph nodes. Future clarification will likely evolve as more data become available.

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Section: Elastic Stain To Identify Elastic Lamina Invasionmentioning

confidence: 84%

“…[13][14][15][16] The elastic stain is useful in assessing involvement of the visceral peritoneum in lung cancers, and is used in AJCC TNM 7th edition to help stage lung cancers. The subserosal elastic lamina is located just deep to the peritoneum in the colon.…”

Section: Elastic Stain To Identify Elastic Lamina Invasionmentioning

confidence: 99%

Serosal surfaces, mucin pools, and deposits, Oh my: challenges in staging colorectal carcinoma

Frankel

Jin

2015

Modern Pathology

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“…We employed EM staining to measure the depth of tumor invasion. Although Victoria blue and elastica-van Gieson staining are also useful for recognizing an invasion of the adventitia and/or vessels, 16,17 we considered that EM staining was most helpful for identifying the border of the MP as a demarcation point for measurement. Initially, we examined the extent of tumor invasion in 147 cases of curatively resected CRC and analyzed various clinicopathological factors including the prognosis.…”

Section: Discussionmentioning

confidence: 99%

Depth of tumor invasion in locally advanced rectal cancer correlates with patients’ prognosis: The usefulness of elastic stain for its measurement

et al. 2008

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“…These observations underline that because correctly identifying pT4 tumors preoperatively and perioperatively remains difficult, patients selected for the COLOPEC trial will inevitably undergo a two-stage procedure, primary resection followed by HIPEC. Equally important, pathology studies also showed that, as in lung cancer [86], pT3 tumors invading the peritoneal elastic lamina (30 % of the cases) and pT4 cancers have the same outcome [87][88][89][90]. Studies designed to decide on the therapeutic strategy before the definitive pathological assessment are therefore unable to consider pT3 and pT4 tumors separately.…”

Section: Proactive Management Of Peritoneal Metastases From Colorectamentioning

confidence: 99%

“…The studies conducted by several far eastern authors show that the subserosal elastic lamina is an anatomic landmark for stratifying pT3 colorectal cancer. When a pT3 tumor invades the subserosal elastic lamina, as it does in 30 % of the cases currently classified as pT3, the clinical outcome almost matches that in patients with pT4 cancer [87][88][89][90].…”

Section: Proactive Management Of Peritoneal Metastases From Colorectamentioning

confidence: 99%

Proactive Management for Gastric, Colorectal and Appendiceal Malignancies: Preventing Peritoneal Metastases with Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Sammartino

Biacchi

Cornali

et al. 2016

Indian J Surg Oncol

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An integrated treatment strategy using peritonectomy procedures plus hyperthermic intraperitoneal chemotherapy (HIPEC) is now a clinical standard of care in selected patients with peritoneal metastases and primary peritoneal tumors. This comprehensive approach can offer many patients, who hitherto had no hope of cure, a good quality of life and survival despite limited morbidity. The increasingly successful results and chance of interfering in the natural history of disease has prompted research to develop for some clinical conditions a therapeutic strategy designed to prevent malignant peritoneal dissemination before it becomes clinically evident and treat it microscopically (tertiary prevention). The main factor governing successful cytoreductive surgery and predicting outcome is the extent of peritoneal spread assessed with the peritoneal cancer index (PCI). In peritoneal metastases from colorectal and gastric cancer the PCI score acquires a specific role acting as the cut-off between patients who can undergo curative surgery or palliation. Long-term results show that the only group enjoying favorable results are patients with limited disease (a statistical minority). By applying to appropriately selected patients with primary malignancies a proactive management strategy including HIPEC we can treat patients with microscopic peritoneal dissemination and therefore at PCI 0. Among treated conditions pseudomyxoma peritonei enjoys the best results. But a major future advance comes from identifying among lesions at major risk of pseudomyxoma.

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The Subserosal Elastic Lamina: An Anatomic Landmark for Stratifying pT3 Colorectal Cancer

Abstract: The newly proposed subserosal elastic lamina classification is a useful subclassification to predict the prognosis of patients with resected pT3 colorectal carcinomas.

Cited by 38 publications

References 16 publications

Serosal surfaces, mucin pools, and deposits, Oh my: challenges in staging colorectal carcinoma

Serosal surfaces, mucin pools, and deposits, Oh my: challenges in staging colorectal carcinoma

Depth of tumor invasion in locally advanced rectal cancer correlates with patients’ prognosis: The usefulness of elastic stain for its measurement

Proactive Management for Gastric, Colorectal and Appendiceal Malignancies: Preventing Peritoneal Metastases with Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

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