scholarly journals Association of Poor Differentiation or Positive Vertical Margin with Residual Disease in Patients with Subsequent Colectomy after Complete Macroscopic Endoscopic Resection of Early Colorectal Cancer

2017 ◽  
Vol 2017 ◽  
pp. 1-8
Author(s):  
Ki Ju Kim ◽  
Hyun Seok Lee ◽  
Seong Woo Jeon ◽  
Sun Jin ◽  
Sang Won Lee
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Endoscopic Resection ◽  
Resection Margin ◽  
Residual Disease ◽  
Early Colorectal Cancer ◽  
Residual Cancer ◽  
Mucinous Histology ◽  
Poor Differentiation ◽  
Poorly Differentiated

In the presence of unfavorable pathologic results after endoscopic resection of colorectal cancer, colectomy is routinely performed. We determined the risk factors for residual diseases in patients with colectomy after complete macroscopic endoscopic resection of early colorectal cancer. We identified consecutive patients who underwent endoscopic resection of early colorectal cancer and subsequently underwent colectomy, from January 2011 to December 2014. Clinicopathologic risk factors related to the residual disease were analyzed. In total, 148 patients underwent endoscopic resection and subsequent colectomy. Residual disease on colectomy was noted in 16 (10.9%) patients. The rates of poorly differentiated/mucinous histology (p=0.028) and of positive or unknown vertical resection margin (p=0.047) were higher in patients with residual disease than in those without. In multivariate analysis, a poorly differentiated/mucinous histology and positive or unknown vertical resection margin were significantly associated with residual disease (odds ratio = 7.508 and 2.048, p=0.015 and 0.049, resp.). After complete macroscopic endoscopic resection of early colorectal cancer, there is a greater need for additional colectomy in cases with a positive or unknown vertical resection margin or a poorly differentiated/mucinous histology, because of their higher risk of residual cancer and lymph node metastasis.

Risk of recurrence after endoscopic resection of early colorectal cancer with positive margins

Endoscopy ◽  
2017 ◽  
Vol 50 (03) ◽  
pp. 241-247 ◽  
Author(s):  
Je-Wook Shin ◽  
Kyung Han ◽  
Jong Hyun ◽  
Sang Lee ◽  
Bun Kim ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Endoscopic Resection ◽  
Resection Margin ◽  
Salvage Surgery ◽  
Positive Margin ◽  
Residual Tumor ◽  
Early Colorectal Cancer ◽  
Clinicopathological Factors ◽  
Positive Resection Margin ◽  
Additional Surgery

Abstract Background and study aim Additional surgery is recommended if an endoscopically resected T1 colorectal cancer (CRC) specimen shows a positive resection margin. We aimed to investigate the significance of a positive resection margin in endoscopically resected T1 CRC. Patients and methods We enrolled 265 patients with T1 CRC who underwent endoscopic resection between January 2001 and December 2016. The inclusion criteria were: 1) complete resection by endoscopy, and 2) pathology of a positive margin. Among the 265 patients, 213 underwent additional surgery and 52 did not. In the additional surgery group, various clinicopathological factors were evaluated with respect to the presence or absence of residual tumor. The follow-up results were assessed in the group that did not undergo additional surgery. Results In the 213 patients who underwent additional surgery, residual tumor was detected in 13 patients (6.1 %), and none of the clinicopathological factors was significantly associated with the presence of residual tumor. Among the 52 patients who did not undergo additional surgery, recurrence was detected in 4 (7.7 %), and all 4 underwent salvage surgery. Among these four patients, three had no risk factors for lymph node metastasis and recurrence was at the previous resection site; pathology was high grade dysplasia, rpT3N0M0, and rpT1N0M0, respectively. Conclusions A positive resection margin in endoscopically resected T1 CRC is related to a relatively low incidence of residual tumor (6.1 %). Although current guidelines recommend additional surgery for such cases, surveillance and timely salvage surgery could be another option in selected cases.

A real world analysis of recurrence risk factors for early colorectal cancer T1 treated with standard endoscopic resection

2020 ◽  
Vol 35 (5) ◽  
pp. 921-927 ◽  
Author(s):  
C. Martínez Vila ◽  
H. Oliveres Montero de Novoa ◽  
E. Martínez-Bauer ◽  
X. Serra-Aracil ◽  
L. Mora ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Endoscopic Resection ◽  
Real World ◽  
Recurrence Risk ◽  
Early Colorectal Cancer

Risk Factors for Lymph Node Metastasis After Endoscopic Resection for Early Colorectal Cancer

2009 ◽  
Vol 69 (5) ◽  
pp. AB301 ◽  
Author(s):  
Seok Won Jung ◽  
In Du Jeong ◽  
Sung-Jo Bang ◽  
Jung Woo Shin ◽  
Neung Hwa Park ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Endoscopic Resection ◽  
Early Colorectal Cancer ◽  
Node Metastasis

scholarly journals Pedunculated early colorectal cancer with nodal metastasis: a case report

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Hiroka Kondo ◽  
Shimpei Ogawa ◽  
Takeshi Ohki ◽  
Yoshiko Bamba ◽  
Yuka Kaneko ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Endoscopic Resection ◽  
Bowel Resection ◽  
Lymphatic Invasion ◽  
Nodal Metastasis ◽  
Early Colorectal Cancer ◽  
Muscularis Mucosa ◽  
Poorly Differentiated Adenocarcinoma ◽  
Additional Surgery ◽  
Poorly Differentiated

Abstract Background Pedunculated polyps are more likely to be amenable to complete resection than non-pedunculated early colorectal cancers and rarely require additional surgery. We encountered a patient with a pedunculated early colorectal cancer that consisted of poorly differentiated adenocarcinoma with lymphatic invasion. We performed an additional bowel resection and found nodal metastasis. Case presentation A 43-year-old woman underwent colonoscopy after a positive fecal occult blood test. The colonoscopist found a 20-mm pedunculated polyp in the descending colon and performed endoscopic resection. Histopathologic examination revealed non-solid type poorly differentiated adenocarcinoma. The lesion invaded the submucosa (3500 μm from the muscularis mucosa) and demonstrated lymphatic invasion. In spite of the early stage of this cancer, the patient was considered at high risk for nodal metastasis. She was referred to our institution, where she underwent bowel resection. Although there was no residual cancer after her endoscopic resection, a metastatic lesion was found in one regional lymph node. The patient is undergoing postoperative adjuvant chemotherapy, and there has been no evidence of recurrence 3 months after the second surgery. Conclusions Additional bowel resection is indicated for patients with pedunculated polyps and multiple risk factors for nodal metastasis, such as poorly differentiated adenocarcinoma and lymphatic invasion. We encountered just such a patient who did have a nodal metastasis; herein, we report her case history with a review of the literature.

Risk Assessment in Early Colorectal Cancer: Histological and Molecular Markers

2014 ◽  
Vol 33 (1) ◽  
pp. 77-85 ◽  
Author(s):  
Annika Resch ◽  
Cord Langner
Keyword(s):  
Colorectal Cancer ◽  
Molecular Markers ◽  
High Risk ◽  
Resection Margin ◽  
Classification Systems ◽  
Pathological Examination ◽  
Early Colorectal Cancer ◽  
Depth Of Invasion ◽  
Adequate Treatment ◽  
Poor Differentiation

The pathological examination of early colorectal cancer specimens, in particular ‘malignant polyps', provides important prognostic information. The depth of invasion into the submucosal layer assessed according to the Haggitt (for pedunculated lesions) or Kikuchi (for nonpolypoid lesions) classification systems or by direct measurement has been associated with the risk of lymph node metastasis. Angioinvasion, in particular lymphatic invasion, budding, tumor differentiation or grade, and resection margin status have been identified as further risk factors. The combination of these parameters allows the stratification of affected individuals into low- and high-risk categories, which is pivotal for clinical management. For low-risk cancers, defined as a completely excised Haggitt level 1-3/Kikuchi sm1 tumor with no evidence of poor differentiation or angioinvasion, local excision is generally regarded as adequate treatment. Oncological surgical resection is, however, indicated for high-risk cancers, which show at least one of the following features: Haggitt level 4/Kikuchi sm3 invasion, the presence of lymphatic (or vascular) invasion, poor differentiation, or positive resection margin. The inclusion of molecular markers such as tumor suppressor genes and their products, markers involved in tumor vascularization, and markers related to tumor cell adhesion and invasion may help to refine risk stratification, but data on molecular markers are still limited in this regard.

scholarly journals Retrospective analysis of LNM risk factors and the effect of chemotherapy in early colorectal cancer: A Chinese multicenter study

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chunyan Zeng ◽  
Dandan Xiong ◽  
Fei Cheng ◽  
Qingtian Luo ◽  
Qiang Wang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Multicenter Study ◽  
Tumor Size ◽  
Lymphovascular Invasion ◽  
Univariate Analysis ◽  
Tumor Location ◽  
Early Colorectal Cancer ◽  
Depth Of Invasion ◽  
Significant Difference

Abstract Background Estimating the risk of lymph node metastasis (LNM) is crucial for determining subsequent treatments following curative resection of early colorectal cancer (ECC). This multicenter study analyzed the risk factors of LNM and the effectiveness of postoperative chemotherapy in patients with ECC. Methods We retrospectively analyzed the data of 473 patients with ECC who underwent general surgery in five hospitals between January 2007 and October 2018. The correlations between LNM and sex, age, tumor size, tumor location, endoscopic morphology, pathology, depth of invasion and tumor budding (TB) were directly estimated based on postoperative pathological analysis. We also observed the overall survival (OS) and recurrence in ECC patients with and without LNM after matching according to baseline measures. Results In total, 473 ECC patients were observed, 288 patients were enrolled, and 17 patients had LNM (5.90%). The univariate analysis revealed that tumor size, pathology, and lymphovascular invasion were associated with LNM in ECC (P = 0.026, 0.000, and 0.000, respectively), and the multivariate logistic regression confirmed that tumor size, pathology, and lymphovascular invasion were risk factors for LNM (P = 0.021, 0.023, and 0.001, respectively). There were no significant differences in OS and recurrence between the ECC patients with and without LNM after matching based on baseline measures (P = 0.158 and 0.346, respectively), and no significant difference was observed between chemotherapy and no chemotherapy in ECC patients without LNM after surgery (P = 0.729 and 0.052). Conclusion Tumor size, pathology, and lymphovascular invasion are risk factors for predicting LNM in ECC patients. Adjuvant chemotherapy could improve OS and recurrence in patients with LNM but not always in ECC patients without LNM.

Clinical outcomes of positive resection margins after endoscopic resection of early colorectal cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 688-688
Author(s):  
Jin-Oh Kim
Keyword(s):  
Cancer Cells ◽  
Clinical Outcomes ◽  
Cancer Cell ◽  
Endoscopic Resection ◽  
Resection Margin ◽  
Early Colorectal Cancer ◽  
Resection Margins ◽  
Positive Resection Margin ◽  
Positive Group ◽  
Positive Resection Margins

688 Background: The management of patients with a positive resection margin after endoscopic resection of early colorectal cancer (ECC) depends on various clinical factors, including the pathology. There is little information on the clinical outcomes according to the subsequent management of a positive resection margin in patients with ECC treated by endoscopic resection. We assessed the management according to the pathology of the positive margin and evaluated the clinical outcomes. Methods: Consecutive patients with ECC who underwent endoscopic resection from January 2004 to December 2014 were reviewed. This study retrospectively analyzed 363 lesions from 338 patients (mean age, 60.1 years; 68% [230/338] male). Results: The resection margin was positive in 29.2% of patients, including cancer cells in 9.9%, adenoma in 16.5%, and high-grade dysplasia (HGD) in 2.8%. Subsequent surgery was performed on 11.8% of patients, 72.2% (26/43) of whom were cancer cell–positive, while 23.3% (10/43) were resection margin–negative but had deep submucosal (SM) or lymphatic invasion. Remnant cancer cells were identified in 25.6% (11/43) of the operated group and 81.8% (9/11) of the cancer cell–positive group. On early follow-up surveillance colonoscopy (mean interval, 3.57 months) in 88.2% of patients (320/363), including 95.7% (67/70) of the adenoma and HGD-positive group, only one (0.3%, 1/320) case of remnant adenoma was found. In the multivariate analysis, deep SM invasion ( p=0.026), number of pieces of piecemeal resection (p=0.03) and cancer cell positivity ( p=0.001) predicted subsequent surgery. In the multivariate analysis, an endoscopic appearance of incomplete resection ( p=0.002) and cancer cell positivity (p=0.041) were related to the identification of remnant cancer cells after subsequent surgery. Conclusions: Patients with an adenoma-positive resection margin had favorable clinical outcomes during subsequent surveillance. The choice of subsequent surgery was related to deep SM invasion and cancer cell–positive resection margins, and subsequent surgery group showed a high rate of remnant cancer cells.

Complete laparoscopic surgery for early colorectal cancer after endoscopic resection

2013 ◽  
Vol 6 (4) ◽  
pp. 338-341
Author(s):  
Shungo Endo ◽  
Yusuke Takehara ◽  
Jun-ichi Tanaka ◽  
Eiji Hidaka ◽  
Shumpei Mukai ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Laparoscopic Surgery ◽  
Endoscopic Resection ◽  
Early Colorectal Cancer
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