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Dang H, Dekkers N, le Cessie S, van Hooft JE, van Leerdam ME, Oldenburg PP, Flothuis L, Schoones JW, Langers AMJ, Hardwick JCH, van der Kraan J, Boonstra JJ. Risk and Time Pattern of Recurrences After Local Endoscopic Resection of T1 Colorectal Cancer: A Meta-analysis. Clin Gastroenterol Hepatol 2022; 20:e298-e314. [PMID: 33271339 DOI: 10.1016/j.cgh.2020.11.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Growing numbers of patients with T1 CRC are being treated with local endoscopic resection only and as a result, the need for optimization of surveillance strategies for these patients also increases. We aimed to estimate the cumulative incidence and time pattern of CRC recurrences for endoscopically treated patients with T1 CRC. METHODS Using a systematic literature search in PubMed, EMBASE, Web of Science and Cochrane Library (from inception till 15 May 2020), we identified and extracted data from studies describing the cumulative incidence of local or distant CRC recurrence for patients with T1 CRC treated with local endoscopic resection only. Pooled estimates were calculated using mixed-effect logistic regression models. RESULTS Seventy-one studies with 5167 unique, endoscopically treated patients with T1 CRC were included. The pooled cumulative incidence of any CRC recurrence was 3.3% (209 events; 95% CI, 2.6%-4.3%; I2 = 54.9%), with local and distant recurrences being found at comparable rates (pooled incidences 1.9% and 1.6%, respectively). CRC-related mortality was observed in 42 out of 2519 patients (35 studies; pooled incidence 1.7%, 95% CI, 1.2%-2.2%; I2 = 0%), and the CRC-related mortality rate among patients with recurrence was 40.8% (42/103 patients). The vast majority of recurrences (95.6%) occurred within 72 months of follow-up. Pooled incidences of any CRC recurrence were 7.0% for high-risk T1 CRCs (28 studies; 95% CI, 4.9%-9.9%; I2 = 48.1%) and 0.7% (36 studies; 95% CI, 0.4%-1.2%; I2 = 0%) for low-risk T1 CRCs. CONCLUSIONS Our meta-analysis provides quantitative outcome measures which are relevant to guidelines on surveillance after local endoscopic resection of T1 CRC.
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Affiliation(s)
- Hao Dang
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Nik Dekkers
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Saskia le Cessie
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Philip P Oldenburg
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Louis Flothuis
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan W Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexandra M J Langers
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - James C H Hardwick
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jolein van der Kraan
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jurjen J Boonstra
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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Park CH, Yang DH, Kim JW, Kim JH, Kim JH, Min YW, Lee SH, Bae JH, Chung H, Choi KD, Park JC, Lee H, Kwak MS, Kim B, Lee HJ, Lee HS, Choi M, Park DA, Lee JY, Byeon JS, Park CG, Cho JY, Lee ST, Chun HJ. [Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 75:264-291. [PMID: 32448858 DOI: 10.4166/kjg.2020.75.5.264] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 12/15/2022]
Abstract
Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.
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Affiliation(s)
- Chan Hyuk Park
- Department of Gastroenterology, Hanyang University Guri Hospital, Guri, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, Seoul, Korea
| | - Jong Wook Kim
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jie-Hyun Kim
- Department of Gastroenterology, Yonsei University Gangnam Severance Hospital, Seoul, Korea
| | - Ji Hyun Kim
- Department of Gastroenterology, Inje University Busan Paik Hospital, Busan, Korea
| | - Yang Won Min
- Department of Gastroenterology, Samsung Medical Center, Seoul, Korea
| | - Si Hyung Lee
- Department of Gastroenterology, Yeungnam University Medical Center, Daegu, Korea
| | - Jung Ho Bae
- Department of Gastroenterology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Hyunsoo Chung
- Department of Gastroenterology, Seoul National University Hospital, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, Seoul, Korea
| | - Jun Chul Park
- Department of Gastroenterology, Yonsei University Severance Hospital, Seoul, Korea
| | - Hyuk Lee
- Department of Gastroenterology, Samsung Medical Center, Seoul, Korea
| | - Min-Seob Kwak
- Department of Gastroenterology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Bun Kim
- Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
| | - Hyun Jung Lee
- Department of Gastroenterology, Seoul National University Hospital, Seoul, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Dong-Ah Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jong Yeul Lee
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, Seoul, Korea
| | - Chan Guk Park
- Department of Gastroenterology, Chosun University Hospital, Gwangju, Korea
| | - Joo Young Cho
- Department of Gastroenterology, Cha University Bundang Medical Center, Seongnam, Korea
| | - Soo Teik Lee
- Department of Gastroenterology, Jeonbuk National University Hospital, Jeonju, Korea
| | - Hoon Jai Chun
- Department of Gastroenterology, Korea University Anam Hospital, Seoul, Korea
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3
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Park CH, Yang DH, Kim JW, Kim JH, Kim JH, Min YW, Lee SH, Bae JH, Chung H, Choi KD, Park JC, Lee H, Kwak MS, Kim B, Lee HJ, Lee HS, Choi M, Park DA, Lee JY, Byeon JS, Park CG, Cho JY, Lee ST, Chun HJ. Clinical practice guideline for endoscopic resection of early gastrointestinal cancer. Intest Res 2020; 19:127-157. [PMID: 33045799 PMCID: PMC8100377 DOI: 10.5217/ir.2020.00020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/11/2020] [Indexed: 12/16/2022] Open
Abstract
Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.
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Affiliation(s)
- Chan Hyuk Park
- Department of Gastroenterology, Hanyang University Guri Hospital, Guri, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, Seoul, Korea
| | - Jong Wook Kim
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jie-Hyun Kim
- Department of Gastroenterology, Yonsei University Gangnam Severance Hospital, Seoul, Korea
| | - Ji Hyun Kim
- Department of Gastroenterology, Inje University Busan Paik Hospital, Busan, Korea
| | - Yang Won Min
- Department of Gastroenterology, Samsung Medical Center, Seoul, Korea
| | - Si Hyung Lee
- Department of Gastroenterology, Yeungnam University Medical Center, Daegu, Korea
| | - Jung Ho Bae
- Department of Gastroenterology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Hyunsoo Chung
- Department of Gastroenterology, Seoul National University Hospital, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, Seoul, Korea
| | - Jun Chul Park
- Department of Gastroenterology, Yonsei University Severance Hospital, Seoul, Korea
| | - Hyuk Lee
- Department of Gastroenterology, Samsung Medical Center, Seoul, Korea
| | - Min-Seob Kwak
- Department of Gastroenterology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Bun Kim
- Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
| | - Hyun Jung Lee
- Department of Gastroenterology, Seoul National University Hospital, Seoul, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Dong-Ah Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jong Yeul Lee
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, Seoul, Korea
| | - Chan Guk Park
- Department of Gastroenterology, Chosun University Hospital, Gwangju, Korea
| | - Joo Young Cho
- Department of Gastroenterology, Cha University Bundang Medical Center, Seongnam, Korea
| | - Soo Teik Lee
- Department of Gastroenterology, Jeonbuk National University Hospital, Jeonju, Korea
| | - Hoon Jai Chun
- Department of Gastroenterology, Korea University Anam Hospital, Seoul, Korea
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4
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Park CH, Yang DH, Kim JW, Kim JH, Kim JH, Min YW, Lee SH, Bae JH, Chung H, Choi KD, Park JC, Lee H, Kwak MS, Kim B, Lee HJ, Lee HS, Choi M, Park DA, Lee JY, Byeon JS, Park CG, Cho JY, Lee ST, Chun HJ. Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2020. [DOI: 10.7704/kjhugr.2020.0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.
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McBride R, Hicks BM, Coleman HG, Loughrey MB, Gavin AT, Dunne PD, Campbell WJ. Prognosis following surgical resection versus local excision of stage pT1 colorectal cancer: A population-based cohort study. Surgeon 2020; 18:65-74. [PMID: 31402122 DOI: 10.1016/j.surge.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 04/09/2019] [Accepted: 06/10/2019] [Indexed: 11/18/2022]
Abstract
AIMS To evaluate patient management following stage pT1 colorectal cancer (CRC) diagnosis, and to determine if surgical resection improved outcome compared with local excision, within a population-based study. METHODS Data were collected from the Northern Ireland Cancer Registry. Cases of stage pT1 CRC diagnosed from 2007 to 2012 were identified. Analyses were conducted using Cox proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (CI) for cancer-specific and all-cause mortality for individuals undergoing formal surgery versus local excision. RESULTS 394 patients with pT1 CRC were included. Of these, 37.1% were treated by local resection, 36.8% had biopsy followed by surgery and 26.1% had local excision followed by surgery. There were 60 deaths over a mean 4.8 years of follow-up, including 10 CRC-specific deaths. An additional 12 patients had a CRC recurrence or metastases during follow-up. Of the CRC-specific deaths or recurrences, 27.3% had local excision only. Individuals treated by formal surgery did not have a reduced risk of CRC-specific death (adjusted HR = 1.51, 95% CI 0.29, 7.89), but did have a reduced risk of all-cause mortality (adjusted HR = 0.51 95% CI 0.30, 0.87) compared with those undergoing local excision only. CONCLUSIONS Patients with stage pT1 CRC undergoing formal surgery had a reduced risk of all-cause mortality compared with those treated by local excision only. However, this was not explained by a reduced risk of recurrence/disease-free survival or CRC death, and suggests that the observed benefits may simply reflect selection of a healthier patient population in the formal surgery group.
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Affiliation(s)
- Rachael McBride
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom.
| | - Blanaid M Hicks
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Helen G Coleman
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom; Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Maurice B Loughrey
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom; Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Anna T Gavin
- Northern Ireland Cancer Registry, Belfast, Northern Ireland, United Kingdom
| | - Philip D Dunne
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - W Jeffrey Campbell
- South Eastern Health and Social Care Trust, Ulster Hospital, Dundonald, Northern Ireland, United Kingdom
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6
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Park CH, Yang DH, Kim JW, Kim JH, Kim JH, Min YW, Lee SH, Bae JH, Chung H, Choi KD, Park JC, Lee H, Kwak MS, Kim B, Lee HJ, Lee HS, Choi M, Park DA, Lee JY, Byeon JS, Park CG, Cho JY, Lee ST, Chun HJ. Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer. Clin Endosc 2020; 53:142-166. [PMID: 32252507 PMCID: PMC7137564 DOI: 10.5946/ce.2020.032] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/23/2020] [Indexed: 12/12/2022] Open
Abstract
Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by <i>en bloc</i> fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.
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Affiliation(s)
- Chan Hyuk Park
- Department of Gastroenterology, Hanyang University Guri Hospital, Guri, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, Seoul, Korea
| | - Jong Wook Kim
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jie-Hyun Kim
- Department of Gastroenterology, Yonsei University Gangnam Severance Hospital, Seoul, Korea
| | - Ji Hyun Kim
- Department of Gastroenterology, Inje University Busan Paik Hospital, Busan, Korea
| | - Yang Won Min
- Department of Gastroenterology, Samsung Medical Center, Seoul, Korea
| | - Si Hyung Lee
- Department of Gastroenterology, Yeungnam University Medical Center, Daegu, Korea
| | - Jung Ho Bae
- Department of Gastroenterology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Hyunsoo Chung
- Department of Gastroenterology, Seoul National University Hospital, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, Seoul, Korea
| | - Jun Chul Park
- Department of Gastroenterology, Yonsei University Severance Hospital, Seoul, Korea
| | - Hyuk Lee
- Department of Gastroenterology, Samsung Medical Center, Seoul, Korea
| | - Min-Seob Kwak
- Department of Gastroenterology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Bun Kim
- Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
| | - Hyun Jung Lee
- Department of Gastroenterology, Seoul National University Hospital, Seoul, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Dong-Ah Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jong Yeul Lee
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, Seoul, Korea
| | - Chan Guk Park
- Department of Gastroenterology, Chosun University Hospital, Gwangju, Korea
| | - Joo Young Cho
- Department of Gastroenterology, Cha University Bundang Medical Center, Seongnam, Korea
| | - Soo Teik Lee
- Department of Gastroenterology, Jeonbuk National University Hospital, Jeonju, Korea
| | - Hoon Jai Chun
- Department of Gastroenterology, Korea University Anam Hospital, Seoul, Korea
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Senore C, Giovo I, Ribaldone DG, Ciancio A, Cassoni P, Arrigoni A, Fracchia M, Silvani M, Segnan N, Saracco GM. Management of Pt1 tumours removed by endoscopy during colorectal cancer screening: Outcome and treatment quality indicators. Eur J Surg Oncol 2018; 44:1873-1879. [PMID: 30343994 DOI: 10.1016/j.ejso.2018.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 08/22/2018] [Accepted: 09/02/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Limited information is available about outcomes of patients with malignant adenomas endoscopically resected at screening. The aim of the study was to evaluate diagnostic and therapeutic quality indicators and to correlate them with clinical and surgical outcomes. MATERIALS AND METHODS We reviewed endoscopic and histology characteristics of all pT1 tumours endoscopically removed at the time of colonoscopy assessment in subjects with a positive screening test result in the context of a population-based program. RESULTS 392 pT1 tumours were completely removed by endoscopy (en-bloc = 86.7%, piecemeal = 13.3%) and the histology report was considered complete in 83.2% of cases. Treatment was limited to endoscopic excision for 120 patients (30.7%, Group 1), 272 (69.3%, Group 2) underwent radicalisation surgery. In patients who had at least 1 lymph node examined, the rate of nodal involvement was 5.4% (13/239); no metastatic node was found in the 21 (27.6%) out of 76 patients with low-risk adenomas, who underwent surgery. CONCLUSION Risk of nodal involvement in colorectal pT1 tumours is well predicted by known histologic features also in a screening setting, although it was lower than among patients from clinical series. Surgical overtreatment is still significantly present and there is ample room for improvement regarding diagnostic and therapeutic flow-chart.
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Affiliation(s)
- Carlo Senore
- Cancer Epidemiology Unit, CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | - Ilaria Giovo
- Division of Gastroenterology, Department of Medical Sciences, Molinette Hospital, University of Turin, Italy
| | - Davide Giuseppe Ribaldone
- Division of Gastroenterology, Department of Medical Sciences, Molinette Hospital, University of Turin, Italy.
| | - Alessia Ciancio
- Division of Gastroenterology, Department of Medical Sciences, Molinette Hospital, University of Turin, Italy
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, Molinette Hospital, University of Turin, Italy
| | - Arrigo Arrigoni
- Division of Gastroenterology, Department of Medical Sciences, Molinette Hospital, University of Turin, Italy
| | - Mario Fracchia
- Division of Gastroenterology, Mauriziano Hospital, Turin, Italy
| | - Marco Silvani
- Cancer Epidemiology Unit, CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | - Nereo Segnan
- Cancer Epidemiology Unit, CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | - Giorgio Maria Saracco
- Division of Gastroenterology, Department of Medical Sciences, Molinette Hospital, University of Turin, Italy
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Leung FW. Incomplete resection after macroscopic radical endoscopic resection of T1 colorectal cancer-should a paradigm-changing approach to address the risk be considered? Transl Gastroenterol Hepatol 2017; 2:69. [PMID: 28905010 PMCID: PMC5590022 DOI: 10.21037/tgh.2017.08.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 07/17/2017] [Indexed: 08/30/2023] Open
Affiliation(s)
- Felix W. Leung
- Sepulveda Ambulatory Care Center, North Hill, CA, USA
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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9
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Macias-Garcia F, Celeiro-Muñoz C, Lesquereux-Martinez L, Gude-Sampedro F, Uribarri-Gonzalez L, Abdulkader I, Alvarez-Castro A, Dominguez-Muñoz JE. A clinical model for predicting lymph node metastasis in submucosal invasive (T1) colorectal cancer. Int J Colorectal Dis 2015; 30:761-8. [PMID: 25700808 DOI: 10.1007/s00384-015-2164-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND No single histopathological feature of submucosal invasive colorectal cancer (T1-CRC) can reliably predict the risk for lymph node metastasis (LNM). AIM The purpose of the study was to develop a prediction model of LNM in T1-CRC. METHODS Ninety-seven surgically resected T1-CRC at our institution were retrospectively evaluated. Morphology, localization, grading, mode of growth, presence of background adenoma, lymphoid infiltration, angiolymphatic invasion, budding, and depth of invasion were assessed. Mortality and morbidity related to surgery were also evaluated. Benefit-risk balance was assessed according to the presence of severe complications and to the presence of LNM. RESULTS Fourteen cases had LNM (14%). Eight patients (8%) presented severe surgical complications and there were two deaths (2 %). Infiltrative growth pattern (OR 31.91, 95% CI 2.37-428.36; p = 0.009) and the absence of lymphoid infiltrate (OR 28.75; 95% CI 2.13-388.37; p = 0.011) were the only variables independently associated with LNM in the multivariate analysis. Both variables were included in the prediction model together with sessile morphology (OR 4.88; 95% CI 0.81-29.3; p = 0.083) and poorly differentiated carcinoma (OR 11.77; 95% CI 0.77-179.83; p = 0.076). A 0-100 score was developed (infiltrative growth pattern: no = 0, yes = 33; lymphoid infiltrate: no = 29, yes = 0; sessile morphology: no = 0, yes = 15; poorly differentiated: no = 0, yes = 23). Cutoff point to indicate additional surgery was set in 35 points (i.e., 10% risk LNM). Discrimination of the prediction model was excellent (AUC 0.90; 95% CI 0.81-0.99). CONCLUSION Combined evaluation of infiltrative growth pattern, lymphoid infiltration, poorly differentiated carcinoma, and sessile appearance showed good performance for discriminating T1-CRC patients with LNM. The benefit-risk balance was in favor of surgery when at least two of these criteria were present.
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Affiliation(s)
- Fernando Macias-Garcia
- Gastroenterology Department, University Hospital of Santiago de Compostela, c/Choupana s/n, 15706, Santiago de Compostela, Spain,
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