scholarly journals Predictive Factors of Positive Circumferential and Longitudinal Margins in Early T3 Colorectal Cancer Resection

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
M. Ashraf Balbaa ◽  
Noha Elkady ◽  
Emad M. Abdelrahman
Keyword(s):  
Colorectal Cancer ◽  
Resection Margin ◽  
Management Plan ◽  
Positive Lymph Node ◽  
Pathological Examination ◽  
Resection Margins ◽  
Colorectal Cancer Resection ◽  
Signet Ring ◽  
Node Metastases ◽  
Signet Ring Carcinoma

Background. Malignant involvement of circumferential resection margin (CRM) and longitudinal resection margin (LRM) after surgical resection of colorectal cancer (CRC) are associated with higher rates of recurrence and development of distant metastasis. This can influence the overall patient’s prognosis. The aim of the current study was to identify pathological factors as predictors for the involvement of resection margins in early T3 CRC. Patients and Methods. Fifty patients radiologically diagnosed to have cT3a/b (CRC) were included in the study. After resection, the pathological examination was performed to identify patients with positive CRM and/or LRM. Relations between the different pathological parameters and the CMR and LRM involvements were assessed. Results. Positive CRM was present in 17 cases (34%), while positive LRM was found in 6 cases (12%). The involvement of both margins was significantly associated with rectal tumors and tumors with infiltrative gross appearance, grade III, deeper invasion, and positive lymph node metastases. Also, there was a significant association between both margins’ positivity and other pathological parameters as signet ring carcinoma, tumor budding, perineural and vascular invasion, high microvessel density (MVD), and sinusoidal vascular pattern, while the presence of necrosis and infiltrative advancing tumor front was significantly associated with CRM involvement only. The depth of tumor invasion and signet ring carcinoma were identified as independent predictor factors for positive CRM and LRM, respectively. Conclusion. Preoperative identification of these pathological parameters can be a guide to tailor the management plan accordingly.

scholarly journals Management of colorectal polyp cancers

2012 ◽  
Vol 94 (8) ◽  
pp. 574-578 ◽  
Author(s):  
S Naqvi ◽  
S Burroughs ◽  
HS Chave ◽  
G Branagan
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Resection Margin ◽  
Adverse Outcome ◽  
Colorectal Polyps ◽  
Adverse Outcomes ◽  
Resection Margins ◽  
Residual Tumour ◽  
Clear Resection Margin ◽  
Node Metastases

INTRODUCTION Management of malignant colorectal polyps is controversial. The options are resection or surveillance. Resection margin status is accepted as an independent predictor of adverse outcome. However, the rate of adverse outcome in polyps with a resection margin of <1mm has not been investigated. METHODS A retrospective search of the pathology database was undertaken. All polyp cancers were included. A single histopathologist reviewed all of the included polyp cancers. Polyps were divided into three groups: clear resection margin, involved resection margin and unknown resection margin. Polyps were also analysed for tumour grade, morphology, Haggitt/Kikuchi level and lymphovascular invasion. Adverse outcome was defined as residual tumour at the polypectomy site and/or lymph node metastases in the surgical group and local or distant recurrence in the surveillance group. RESULTS Sixty-five polyps (34 male patients, mean age: 73 years, range: 50–94 years) were included. Forty-six had clear polyp resection margins; none had any adverse outcomes. Sixteen patients had involved polyp resection margins and twelve of these underwent surgery: seven had residual tumour and two of these patients had lymph node metastases. Four underwent surveillance, of whom two developed local recurrence. Three patients had resection margins on which the histopathologist was unable to comment. All patients with a clear resection margin had no adverse outcome regardless of other predictive factors. CONCLUSIONS Polyp cancers with clear resection margins, even those with <1mm clearance, can be treated safely with surveillance in our experience. Polyp cancers with unknown or involved resection margins should be treated surgically.

scholarly journals The Pattern of Colorectal Cancer Surgery in Lithuania in 2005: Do Results Meet Expectations?

Medicina ◽  
2013 ◽  
Vol 49 (3) ◽  
pp. 20 ◽  
Author(s):  
Eligijus Poškus ◽  
Saulius Mikalauskas ◽  
Valdemaras Jotautas ◽  
Paulius Žeromskas ◽  
Tomas Poškus ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Complications ◽  
Demographic Data ◽  
Preoperative Evaluation ◽  
University Hospital ◽  
Pathological Examination ◽  
National Database ◽  
Resection Margins ◽  
Neoadjuvant Radiotherapy ◽  
Vilnius University

The aim of this study was to expose the pattern of the surgical treatment of colorectal cancer in Lithuania in 2005. Material and Methods. A retrospective analysis of 590 patients treated for colorectal cancer in the surgical departments of the Hospital of Lithuanian University of Health Sciences, the Institute of Oncology of Vilnius University, and Vilnius University Hospital Santariškių Klinikos in 2005 was performed. Demographic data, preoperative evaluation, postoperative complications assessed according to the Clavien-Dindo classification, the quality of pathological examination, and survival rates were analyzed. Results. A total of 590 patients, 269 women (45.6%) and 321 men (54.4%), were included in this study; the mean age was 68.3 years (SD, 11.2). Tumors were found in the colon of 274 patients (46.4%) and in the rectum of 316 patients (53.6%). An abdominal ultrasound scan was preoperatively performed in 516 patients (87.5%) and a chest x-ray in 316 patients (53.6%); 35 patients (5.9%) underwent abdominal computed tomography. Endorectal ultrasound was done in 99 (31.7%) cases. Neoadjuvant radiotherapy for T3 and T4 rectal tumors was applied in 42 cases (18.1%). Besides, 211 patients (35.8%) developed postoperative complications with an anastomotic leak emerging in 20 cases (3.4%). Death occurred in 7 patients (1.18%). On the average, 11.15 lymph nodes (SD, 6.02) were found in pathological specimens. Circumferential resection margins were assessed in 58 cases (18.4%). The overall 5-year survival rate was 52.06%. Conclusions. The preoperative evaluation and the treatment of patients with colorectal cancer were not sufficiently consistent in Lithuania in 2005. In order to improve the treatment of colorectal cancer, standardization or the national database of colorectal cancer is necessary.

The Effect of Formalin Fixation on Resection Margins in Colorectal Cancer

2019 ◽  
Vol 27 (7) ◽  
pp. 700-705
Author(s):  
David Lam ◽  
Yui Kaneko ◽  
Adam Scarlett ◽  
Basil D’Souza ◽  
Richard Norris ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Circumferential Resection Margin ◽  
Resection Margin ◽  
Neoadjuvant Chemoradiotherapy ◽  
Recurrence Risk ◽  
Formalin Fixation ◽  
Resection Margins ◽  
Distal Resection Margin ◽  
Radial Margin

Resection margins in colorectal cancer carry clinical significance with regard to disease recurrence risk and selection for multimodal adjuvant therapy, especially with circumferential resection margins in rectal cancer. Colorectal cancer specimens are routinely fixed in formalin, which results in specimen and tumor-free margin shrinkage. However, the effects of shrinkage have not traditionally been taken into account when analyzing tumor-free margins. In this prospective study, 46 colorectal cancer specimens were measured in the fresh state and subsequently after formalin fixation for total specimen length, distal resection margin, and radial margin (circumferential resection margin for rectal cancer). The mean reduction after formalin fixation was 17.48 mm (14.7%) for distal resection margin and 1.20 mm (10.5%) for radial margin. For rectal cancer, circumferential resection margin reduction was 0.88 mm (11.8%); this was not affected by neoadjuvant chemoradiotherapy. Duration of formalin fixation did not significantly affect the extent of margin shrinkage. This is the first study to evaluate the effect of formalin fixation on radial resection margins, specifically as it relates to rectal cancer, and it demonstrates that shrinkage from formalin fixation should be a consideration in decision-making where the magnitude of tumor-free margins is small.

scholarly journals Identification of Pancreaticoduodenectomy Resection for Pancreatic Head Adenocarcinoma: A Preliminary Study of Radiomics

2020 ◽  
Vol 2020 ◽  
pp. 1-12 ◽  
Author(s):  
Bei Hui ◽  
Jia-Jun Qiu ◽  
Jin-Heng Liu ◽  
Neng-Wen Ke
Keyword(s):  
Wavelet Transform ◽  
Cancer Cells ◽  
Resection Margin ◽  
Pancreatic Head ◽  
Texture Features ◽  
Pathological Examination ◽  
Resection Margins ◽  
Support Vector ◽  
Svm Classifier ◽  
Preoperative Ct

Background. In a pathological examination of pancreaticoduodenectomy for pancreatic head adenocarcinoma, a resection margin without cancer cells in 1 mm is recognized as R0; a resection margin with cancer cells in 1 mm is recognized as R1. The preoperative identification of R0 and R1 is of great significance for surgical decision and prognosis. We conducted a preliminary radiomics study based on preoperative CT (computer tomography) images to evaluate a resection margin which was R0 or R1. Methods. We retrospectively analyzed 258 preoperative CT images of 86 patients (34 cases of R0 and 52 cases of R1) who were diagnosed as pancreatic head adenocarcinoma and underwent pancreaticoduodenectomy. The radiomics study consists of five stages: (i) delineate and segment regions of interest (ROIs); (ii) by solving discrete Laplacian equations with Dirichlet boundary conditions, fit the ROIs to rectangular regions; (iii) enhance the textures of the fitted ROIs combining wavelet transform and fractional differential; (iv) extract texture features from the enhanced ROIs combining wavelet transform and statistical analysis methods; and (v) reduce features using principal component analysis (PCA) and classify the resection margins using the support vector machine (SVM), and then investigate the associations between texture features and histopathological characteristics using the Mann–Whitney U-test. To reduce overfitting, the SVM classifier embedded a linear kernel and adopted the leave-one-out cross-validation. Results. It achieved an AUC (area under receiver operating characteristic curve) of 0.8614 and an accuracy of 84.88%. Setting p≤0.01 in the Mann–Whitney U-test, two features of the run-length matrix, which are derived from diagonal sub-bands in wavelet decomposition, showed statistically significant differences between R0 and R1. Conclusions. It indicates that the radiomics study is rewarding for the aided diagnosis of R0 and R1. Texture features can potentially enhance physicians’ diagnostic ability.

scholarly journals Gastric Metastasis from Colorectal Cancer Mimicking a Submucosal Tumor

2020 ◽  
Vol 14 (2) ◽  
pp. 338-345
Author(s):  
Naoto Iwai ◽  
Takashi Okuda ◽  
Taishi Harada ◽  
Kohei Oka ◽  
Tasuku Hara ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Transverse Colon ◽  
Submucosal Tumor ◽  
Gastric Body ◽  
Gastric Metastasis ◽  
Poorly Differentiated Adenocarcinoma ◽  
Partial Component ◽  
Signet Ring ◽  
Poorly Differentiated ◽  
Signet Ring Carcinoma

Signet-ring cell carcinoma, a colorectal cancer (CRC) subtype, sometimes shows metastases to uncommon metastatic sites. However, gastric metastasis is extremely rare. Here, we describe a case of gastric metastasis from colonic cancer. A 76-year-old woman presented with anemia. Colonoscopic biopsy revealed a CRC on the transverse colon showing a poorly differentiated adenocarcinoma with a partial component of the signet-ring carcinoma. Computed tomography revealed multiple subcutaneous nodules on her chest and back, and a tumor in the left lower lobe of her lung. Esophagogastroduodenoscopy showed a submucosal tumor-like lesion in the upper gastric body, and endoscopic biopsy revealed the poorly differentiated adenocarcinoma along with the partial component of the signet-ring carcinoma as well as the colonic, subcutaneous, and pulmonary lesion. The findings of endoscopic and microscopic examinations revealed gastric metastasis from CRC on the transverse colon. A systemic chemotherapy was given, and the biopsy conducted 1 year after the initial chemotherapy revealed no evidence of the residual tumor tissue in the gastric lesion. However, best supportive care was recommended depending on metastasis to the rectum. Our case suggests that gastric metastases from CRC should be considered in patients with lesions resembling a submucosal tumor accompanied by central depression and erosion.

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.

472 Addressing the Quality of Hospital Care of Colorectal Cancer Patients Undergoing Surgery: What Did We Learn from the National Bowel Cancer Audit?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
C Li ◽  
S Z Y Ooi ◽  
T Woo ◽  
P H M Chan
Keyword(s):  
Colorectal Cancer ◽  
Cancer Patients ◽  
External Validation ◽  
Distant Metastases ◽  
Management Plan ◽  
Bowel Cancer ◽  
Clinical Factors ◽  
Quality Outcomes ◽  
Colorectal Cancer Patients

Abstract Aim To identify the most relevant clinical factors in the National Bowel Cancer Audit (NBOCA) that contribute to the variation in the quality of care provided in different hospitals for colorectal cancer patients undergoing surgery. Method Data from 36,116 patients with colorectal cancer who had undergone surgery were retrospectively collected from the NBOCA and analysed from 145 and 146 hospitals over two years. A validated multiple linear regression was performed to compare the identified clinical factors with various quality outcomes. The quality outcomes defined in this study were the length of hospitalisation, 2-year mortality, readmission rate, 90-day mortality, and 18-month stoma rate. Results Four clinical factors (laparoscopy rate, abdominal-perineal-resection-of-rectum (APER), pre-operative radiotherapy and patients with distant metastases) were shown to have a significant (p &lt; 0.05) impact on the length of hospitalisation and 18-month stoma rate. 18-month stoma rate was also significantly associated with 2-year mortality. External validation of the regression model demonstrated the Root-Mean-Square-Error of 0.811 and 4.62 for 18-month stoma rate and 2-year mortality respectively. Conclusions Hospitals should monitor the four clinical factors for patients with colorectal cancer during perioperative care. Clinicians should consider these factors along with the individual patients’ history when formulating a management plan for patients with colorectal cancer.

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