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Jung Y. Approaches and considerations in the endoscopic treatment of T1 colorectal cancer. Korean J Intern Med 2024; 39:563-576. [PMID: 38742279 PMCID: PMC11236804 DOI: 10.3904/kjim.2023.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/12/2023] [Accepted: 12/27/2023] [Indexed: 05/16/2024] Open
Abstract
The detection of early colorectal cancer (CRC) is increasing through the implementation of screening programs. This increased detection enhances the likelihood of minimally invasive surgery and significantly lowers the risk of recurrence, thereby improving patient survival and reducing mortality rates. T1 CRC, the earliest stage, is treated endoscopically in cases with a low risk of lymph node metastasis (LNM). The advantages of endoscopic treatment compared with surgery include minimal invasiveness and limited tissue disruption, which reduce morbidity and mortality, preserve bowel function to avoid colectomy, accelerate recovery, and improve cost-effectiveness. However, T1 CRC has a risk of LNM. Thus, selection of the appropriate treatment between endoscopic treatment and surgery, while avoiding overtreatment, is challenging considering the potential for complete resection, LNM, and recurrence risk.
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Affiliation(s)
- Yunho Jung
- Division of Gastroenterology, Department of Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
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Fábián A, Bor R, Vasas B, Szűcs M, Tóth T, Bősze Z, Szántó KJ, Bacsur P, Bálint A, Farkas B, Farkas K, Milassin Á, Rutka M, Resál T, Molnár T, Szepes Z. Long-term outcomes after endoscopic removal of malignant colorectal polyps: Results from a 10-year cohort. World J Gastrointest Endosc 2024; 16:193-205. [PMID: 38680198 PMCID: PMC11045354 DOI: 10.4253/wjge.v16.i4.193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/28/2024] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Choosing an optimal post-polypectomy management strategy of malignant colorectal polyps is challenging, and evidence regarding a surveillance-only strategy is limited. AIM To evaluate long-term outcomes after endoscopic removal of malignant colorectal polyps. METHODS A single-center retrospective cohort study was conducted to evaluate outcomes after endoscopic removal of malignant colorectal polyps between 2010 and 2020. Residual disease rate and nodal metastases after secondary surgery and local and distant recurrence rate for those with at least 1 year of follow-up were investigated. Event rates for categorical variables and means for continuous variables with 95% confidence intervals were calculated, and Fisher's exact test and Mann-Whitney test were performed. Potential risk factors of adverse outcomes were determined with univariate and multivariate logistic regression models. RESULTS In total, 135 lesions (mean size: 22.1 mm; location: 42% rectal) from 129 patients (mean age: 67.7 years; 56% male) were enrolled. The proportion of pedunculated and non-pedunculated lesions was similar, with en bloc resection in 82% and 47% of lesions, respectively. Tumor differentiation, distance from resection margins, depth of submucosal invasion, lymphovascular invasion, and budding were reported at 89.6%, 45.2%, 58.5%, 31.9%, and 25.2%, respectively. Residual tumor was found in 10 patients, and nodal metastasis was found in 4 of 41 patients who underwent secondary surgical resection. Univariate analysis identified piecemeal resection as a risk factor for residual malignancy (odds ratio: 1.74; P = 0.042). At least 1 year of follow-up was available for 117 lesions from 111 patients (mean follow-up period: 5.59 years). Overall, 54%, 30%, 30%, 11%, and 16% of patients presented at the 1-year, 3-year, 5-year, 7-year, and 9-10-year surveillance examinations. Adverse outcomes occurred in 9.0% (local recurrence and dissemination in 4 patients and 9 patients, respectively), with no difference between patients undergoing secondary surgery and surveillance only. CONCLUSION Reporting of histological features and adherence to surveillance colonoscopy needs improvement. Long-term adverse outcome rates might be higher than previously reported, irrespective of whether secondary surgery was performed.
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Affiliation(s)
- Anna Fábián
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Renáta Bor
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Béla Vasas
- Department of Pathology, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Medical Informatics, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6720, Hungary
| | - Tibor Tóth
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Zsófia Bősze
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Kata Judit Szántó
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Péter Bacsur
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Anita Bálint
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Bernadett Farkas
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Klaudia Farkas
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
- USZ Translational Colorectal Research Group, Hungarian Centre of Excellence for Molecular Medicine, Szeged 6725, Hungary
| | - Ágnes Milassin
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Mariann Rutka
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Tamás Resál
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Tamás Molnár
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Zoltán Szepes
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
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Corre F, Albouys J, Tran VT, Lepilliez V, Ratone JP, Coron E, Lambin T, Rahmi G, Karsenti D, Canard JM, Chabrun E, Camus M, Wallenhorst T, Chevaux JB, Schaefer M, Gerard R, Rouquette A, Terris B, Coriat R, Jacques J, Barret M, Pioche M, Chaussade S, Cappelle E. Impact of surgery after endoscopically resected high-risk T1 colorectal cancer: results of an emulated target trial. Gastrointest Endosc 2024; 99:408-416.e2. [PMID: 37793506 DOI: 10.1016/j.gie.2023.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND AND AIMS We aimed to compare the long-term outcomes of patients with high-risk T1 colorectal cancer (CRC) resected endoscopically who received either additional surgery or surveillance. METHODS We used data from routine care to emulate a target trial aimed at comparing 2 strategies after endoscopic resection of high-risk T1 CRC: surgery with lymph node dissection (treatment group) versus surveillance alone (control group). All patients from 14 tertiary centers who underwent an endoscopic resection for high-risk T1 CRC between March 2012 and August 2019 were included. The primary outcome was a composite outcome of cancer recurrence or death at 48 months. RESULTS Of 197 patients included in the analysis, 107 were categorized in the treatment group and 90 were categorized in the control group. From baseline to 48 months, 4 of 107 patients (3.7%) died in the treatment group and 6 of 90 patients (6.7%) died in the control group. Four of 107 patients (3.7%) in the treatment group experienced a cancer recurrence and 4 of 90 patients (4.4%) in the control group experienced a cancer recurrence. After balancing the baseline covariates by inverse probability of treatment weighting, we found no significant difference in the rate of death and cancer recurrence between patients in the 2 groups (weighted hazard ratio, .95; 95% confidence interval, .52-1.75). CONCLUSIONS Our study suggests that patients with high-risk T1 CRC initially treated with endoscopic resection may not benefit from additional surgery.
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Affiliation(s)
- Félix Corre
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Cité University, Paris, France
| | - Jérémie Albouys
- Department of Gastroenterology and Endoscopy, Dupuytren University Hospital, Limoges, France
| | - Viet-Thi Tran
- Paris Cité University and Sorbonne Paris Nord University, INSERM, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | | | | | - Emmanuel Coron
- Department of Gastroenterology and Hepatology, University Hospital of Geneva, Geneva, Switzerland; Digestive Diseases Institute, University Hospital of Nantes, Nantes, France
| | - Thomas Lambin
- Department of Gastroenterology and Endoscopy, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Gabriel Rahmi
- Department of Gastroenterology and Endoscopy, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | - Marine Camus
- Department of Endoscopy, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Timothée Wallenhorst
- Department of Gastroenterology, Pontchaillou University Hospital, Rennes, France
| | | | - Marion Schaefer
- Department of Gastroenterology, Brabois University Hospital, Nancy, France
| | - Romain Gerard
- Department of Gastroenterology, Claude Huriez Hospital, Lille, France
| | - Alexandre Rouquette
- Paris Cité University, Paris, France; Department of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benoit Terris
- Paris Cité University, Paris, France; Department of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Coriat
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Cité University, Paris, France
| | - Jérémie Jacques
- Department of Gastroenterology and Endoscopy, Dupuytren University Hospital, Limoges, France
| | - Maximilien Barret
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Cité University, Paris, France
| | - Mathieu Pioche
- Department of Gastroenterology and Endoscopy, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Stanislas Chaussade
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Cité University, Paris, France
| | - Elisabeth Cappelle
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Cité University, Paris, France
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Gibson DJ, Sidhu M, Zanati S, Tate DJ, Mangira D, Moss A, Singh R, Hourigan LF, Raftopoulos S, Pham A, Kostos P, Kumarasinghe MP, Ruszkiewicz A, McLeod D, Brown GJE, Bourke MJ. Oncological outcomes after piecemeal endoscopic mucosal resection of large non-pedunculated colorectal polyps with covert submucosal invasive cancer. Gut 2022; 71:2481-2488. [PMID: 35256387 DOI: 10.1136/gutjnl-2020-323666] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/25/2022] [Indexed: 12/08/2022]
Abstract
OBJECTIVE Management of covert submucosal invasive cancer (SMIC) discovered after piecemeal endoscopic mucosal resection (pEMR) of large (>20 mm) non-pedunculated colorectal polyps is challenging. The residual cancer risk is largely unknown. We sought to evaluate this in a large tertiary referral cohort. DESIGN Cases of covert SMIC following pEMR were identified and followed. Oncological outcomes after surgery were divided based on residual intramural cancer, lymph node metastases (LNM) or both. Risk factors for residual intramural cancer and LNM were analysed based on the original pEMR histological variables. Risk parameters were analysed with respect to low and high-risk variables for residual intramural cancer and LNM. RESULTS Among 3372 cases of large non-pedunculated colorectal polyps, 143 cases of covert SMIC (4.2%) were identified. 109 underwent surgical resection. Histological analysis of pEMR histology was available in 98 of 109 (90%) cases. 62 cases (63%) had no residual malignancy. 36 cases had residual malignancy (residual intramural cancer n=24; LNM n=5; both n=7). All cases of residual intramural cancer could be identified by a R1 histological deep margin. Cases with poor differentiation (PD) and/or lymphovascular invasion (LVI) had a high risk of LNM (12/33), with a very low risk without these criteria (<1%; 0/65). Cases at low risk for LNM with R0 deep margin have a low risk of residual intramural cancer (<1%; 0/35). CONCLUSION The majority of cases of large non-pedunculated colorectal polyps with covert SMIC following pEMR will have no residual malignancy. The risk of residual malignancy can be ascertained from three key variables: PD, LVI and R1 deep margin.
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Affiliation(s)
- Dave J Gibson
- Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
| | - Mayenaaz Sidhu
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Simon Zanati
- Gastroenterology, Western Health, Footscray, Victoria, Australia
| | - David J Tate
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Dileep Mangira
- Gastroenterology, Western Health, Footscray, Victoria, Australia
| | - Alan Moss
- Department of Gastroenterology, Western Hospital, Footscray, Victoria, Australia
| | - Rajvinder Singh
- Gastroenterology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Luke F Hourigan
- Gastroenterology, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | - Spiro Raftopoulos
- Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Alan Pham
- Anatomical Pathology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Phil Kostos
- Pathology, Western Health, Footscray, Victoria, Australia
| | - M Priyanthi Kumarasinghe
- Department of Anatomical Pathology, PathWest, QEII Medical Centre, Perth, Western Australia, Australia
| | | | - Duncan McLeod
- Institute of Clinical Pathology and Medical Research, Westmead Millennium Institute and Westmead Hospital, University of Sydney, Australia, Westmead Hospital, Westmead, New South Wales, Australia
| | | | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Factors Predicting Malignant Occurrence and Polyp Recurrence after the Endoscopic Resection of Large Colorectal Polyps: A Single Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101440. [PMID: 36295600 PMCID: PMC9611189 DOI: 10.3390/medicina58101440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 12/24/2022]
Abstract
Background: The aim of this study was to identify risk factors contributing to the malignancy of colorectal polyps, as well as risk factors for recurrence after the successful endoscopic mucosal resection of large colorectal polyps in a referral center. Materials and Methods: This retrospective cohort study was performed in patients diagnosed with large (≥20 mm diameter) colorectal polyps and treated in the period from January 2014 to December 2019 at the University Hospital Medical Center Bezanijska Kosa, Belgrade, Serbia. Based on the endoscopic evaluation and classification of polyps, the following procedures were performed: en bloc resection, piecemeal resection or surgical treatment. Results: A total of 472 patients with large colorectal polyps were included in the study. The majority of the study population were male (62.9%), with a mean age of 65.7 ± 10.8 years. The majority of patients had one polyp (73.7%) less than 40 mm in size (74.6%) sessile morphology (46.4%), type IIA polyps (88.2%) or polyps localized in the descending colon (52.5%). The accessibility of the polyp was complicated in 17.4% of patients. En bloc resection was successfully performed in 61.0% of the patients, while the rate of piecemeal resection was 26.1%. Due to incomplete endoscopic resection, surgery was performed in 5.1% of the patients, while 7.8% of the patients were referred to surgery directly. Hematochezia (p = 0.001), type IIB polyps (p < 0.001) and complicated polyp accessibility (p = 0.002) were significant independent predictors of carcinoma presence in a multivariate logistic regression analysis. Out of the 472 patients enrolled in the study, 364 were followed after endoscopic resection for colorectal polyp recurrence, which was observed in 30 patients (8.2%) during follow-up. Piecemeal resection (p = 0.048) and incomplete resection success (p = 0.013) were significant independent predictors of polyp recurrence in the multivariate logistic regression analysis. Conclusions: Whenever an endoscopist encounters a complex colorectal lesion (i.e., a polyp with complicated accessibility), polyp size > 40 mm, the Laterally Spreading Tumor nongranular (LST-NG) morphological type, type IIB polyps or the presence of hematochezia, malignancy risk should be considered before making the decision to either resect, refer to an advanced endoscopist or perform surgery.
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Ábrahám S, Tóth I, Váczi D, Lázár G. [Treatment of the colorectal polyps]. Magy Seb 2022; 75:155-160. [PMID: 35895530 DOI: 10.1556/1046.2022.20010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 01/06/2023]
Abstract
Bevezetés és célkitűzés
A colorectális polypok komplex ellátása komoly kihívást jelent nemcsak az endoszkópos szakemberek, hanem a sebészek számára is.
Anyag és módszerek
A colorectális polypok sebészeti ellátását 2014-ig a hagyományos sebészi per anum polypectomiák vagy lokális excisók (LE) jelentették a szegedi Sebészeti Klinikán. Ezen hagyományos transanális műtéti technikák hátrányai mindenki számára jól ismertek: magas resectiós szél pozitivitás arány, alacsony „en bloc” resectiós arány, valamint a magasabban, 5 cm felett elhelyezkedő léziók eltávolításának nehézségei stb. Mindezek alapján felmerült az igény, hogy a transanális műtétek technikai fejlődésével lépést tartva, nemcsak új műtéti módszert (TAMIS, transanális minimálisan invazív sebészet) vezessünk be, hanem a már jól ismert, de még nem alkalmazott műtéti technikát, úgymint a TEM (transanális endoszkópos mikrosebészet) is alkalmazni kezdjük. Klinikánkon az új sebészi módszerek bevezetése mellett fontosnak tartottuk a sebészi gasztroenterológia, azon belül is a sebészi endoszkópia humán és tárgyi feltételeinek fejlesztését, valamint bővítését is.
Eredmények/következtetések
Az újabb műtéti technikák bevezetése mellett a Sebészeti Klinika Endoszkópos Laborjának fejlesztésével komoly lépéseket tettünk a colorectalis polypok komplex, multidiszciplináris ellátásának terén.
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Affiliation(s)
- Szabolcs Ábrahám
- Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország(tanszékvezető: Prof. Dr. Lázár György)
| | - Illés Tóth
- Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország(tanszékvezető: Prof. Dr. Lázár György)
| | - Dániel Váczi
- Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország(tanszékvezető: Prof. Dr. Lázár György)
| | - György Lázár
- Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország(tanszékvezető: Prof. Dr. Lázár György)
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Alsadhan N, Almaiman A, Pujades-Rodriguez M, Brennan C, Shuweihdi F, Alhurishi SA, West RM. A systematic review of methods to estimate colorectal cancer incidence using population-based cancer registries. BMC Med Res Methodol 2022; 22:144. [PMID: 35590277 PMCID: PMC9118801 DOI: 10.1186/s12874-022-01632-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/04/2022] [Indexed: 11/14/2022] Open
Abstract
Background Epidemiological studies of incidence play an essential role in quantifying disease burden, resource planning, and informing public health policies. A variety of measures for estimating cancer incidence have been used. Appropriate reporting of incidence calculations is essential to enable clear interpretation. This review uses colorectal cancer (CRC) as an exemplar to summarize and describe variation in commonly employed incidence measures and evaluate the quality of reporting incidence methods. Methods We searched four databases for CRC incidence studies published between January 2010 and May 2020. Two independent reviewers screened all titles and abstracts. Eligible studies were population-based cancer registry studies evaluating CRC incidence. We extracted data on study characteristics and author-defined criteria for assessing the quality of reporting incidence. We used descriptive statistics to summarize the information. Results This review retrieved 165 relevant articles. The age-standardized incidence rate (ASR) (80%) was the most commonly reported incidence measure, and the 2000 U.S. standard population the most commonly used reference population (39%). Slightly more than half (54%) of the studies reported CRC incidence stratified by anatomical site. The quality of reporting incidence methods was suboptimal. Of all included studies: 45 (27%) failed to report the classification system used to define CRC; 63 (38%) did not report CRC codes; and only 20 (12%) documented excluding certain CRC cases from the numerator. Concerning the denominator estimation: 61% of studies failed to state the source of population data; 24 (15%) indicated census years; 10 (6%) reported the method used to estimate yearly population counts; and only 5 (3%) explicitly explained the population size estimation procedure to calculate the overall average incidence rate. Thirty-three (20%) studies reported the confidence interval for incidence, and only 7 (4%) documented methods for dealing with missing data. Conclusion This review identified variations in incidence calculation and inadequate reporting of methods. We outlined recommendations to optimize incidence estimation and reporting practices. There is a need to establish clear guidelines for incidence reporting to facilitate assessment of the validity and interpretation of reported incidence. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01632-7.
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Affiliation(s)
- Norah Alsadhan
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia. .,School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Alaa Almaiman
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mar Pujades-Rodriguez
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Cathy Brennan
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Farag Shuweihdi
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sultana A Alhurishi
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Robert M West
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Transanal endoscopic microsurgery after the attempt of endoscopic removal of rectal polyps. Surg Endosc 2022; 36:7738-7746. [PMID: 35246739 PMCID: PMC9485086 DOI: 10.1007/s00464-022-09162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/18/2022] [Indexed: 11/23/2022]
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Cazacu SM, Săftoiu A, Iordache S, Ghiluşi MC, Georgescu CV, Iovănescu VF, Neagoe CD, Streba L, Caliţa M, Burtea ED, Cârţu D, Leru PM. Factors predicting occurrence and therapeutic choice in malignant colorectal polyps: a study of 13 years of colonoscopic polypectomy. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2021; 62:917-928. [PMID: 35673811 PMCID: PMC9289694 DOI: 10.47162/rjme.62.4.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Colorectal carcinoma represents a major cause of mortality and 0.2–12% of resected colonic polyps have malignant cells inside. We performed a retrospective study of patients with resected polyps during a period of 13 years. A total of 905 patients had 2033 polyps removed; 122 polyps (109 patients) had malignant cells. Prevalence of malignant polyps with submucosal invasion was 1.23% and for all polyps with malignant cells was 6%; malignant polyps had a larger size (23.44 mm mean diameter) vs benign polyps (9.63 mm); the risk of malignancy was increased in polyps larger than 10 mm, in lateral spreading lesions and in Paris types 0-Ip, 0-Isp, in sigmoid, descending colon and rectum, in sessile serrated adenoma and traditional serrate adenoma subtypes of serrated lesions and in tubulovillous and villous adenoma. In 18 cases surgery was performed, in 62 patients only colonoscopic follow-up was made and in 35 patients no colonoscopic follow-up was recorded. From initially endoscopic resected polyps, recurrence was noted in seven (11.3%) cases; there was a trend toward association with depth of invasion, piecemeal resection, right and rectum location, sessile and lateral spreading type and pathological subtype. In surgical group, post-therapeutic staging was available in 11 cases; nodal involvement was noted in three (27.27%) cases; none had lymphatic or vascular invasion in endoscopically resected polyps. Four patients with no macroscopic local recurrence underwent surgery with no residual tumor. The rate of metastasis was 16.67% in surgical group and 1.61% in endoscopic group. Evaluation of lymph node (LN) invasion was available for 11 operated patients, with LN invasion (N1) in three patients, local residual tumoral tissue in one patient with incomplete resection and no residual tumor (R0 resection) in four patients with endoscopic resection before surgery.
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Affiliation(s)
- Sergiu Marian Cazacu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Romania; ,
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Mathews AA, Draganov PV, Yang D. Endoscopic management of colorectal polyps: From benign to malignant polyps. World J Gastrointest Endosc 2021; 13:356-370. [PMID: 34630886 PMCID: PMC8474698 DOI: 10.4253/wjge.v13.i9.356] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/17/2021] [Accepted: 08/09/2021] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide and the second leading cause of cancer related death in the world. The early detection and removal of CRC precursor lesions has been shown to reduce the incidence of CRC and cancer-related mortality. Endoscopic resection has become the first-line treatment for the removal of most precursor benign colorectal lesions and selected malignant polyps. Detailed lesion assessment is the first critical step in the evaluation and management of colorectal polyps. Polyp size, location and both macro- and micro- features provide important information regarding histological grade and endoscopic resectability. Benign polyps and even malignant polyps with superficial submucosal invasion and favorable histological features can be adequately removed endoscopically. When compared to surgery, endoscopic resection is associated with lower morbidity, mortality, and higher patient quality of life. Conversely, malignant polyps with deep submucosal invasion and/or high risk for lymph node metastasis will require surgery. From a practical standpoint, the most appropriate strategy for each patient will need to be individualized, based not only on polyp- and patient-related characteristics, but also on local resources and expertise availability. In this review, we provide a broad overview and present a potential decision tree algorithm for the evaluation and management of colorectal polyps that can be widely adopted into clinical practice.
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Affiliation(s)
- April A Mathews
- Division of Pediatric Gastroenterology, University of Florida, Gainesville, FL 32608, United States
| | - Peter V Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL 32608, United States
| | - Dennis Yang
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL 32608, United States
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Jones HJS, Al-Najami I, Baatrup G, Cunningham C. Local excision after polypectomy for rectal polyp cancer: when is it worthwhile? Colorectal Dis 2021; 23:868-874. [PMID: 33306264 DOI: 10.1111/codi.15480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/29/2020] [Accepted: 12/05/2020] [Indexed: 12/27/2022]
Abstract
AIM The optimal management of a polyp cancer that has been removed endoscopically is unclear. Further local excision is often advocated to remove the polyp stalk or scar or to ensure clear margins, but the benefit of this is unclear. The aim of this paper is to determine whether the indications for further local excision can be better defined. METHOD Data were collected from two institutions (in UK and Denmark) which maintain prospective databases to collect information on all patients undergoing transanal endoscopic microsurgery (TEM). The study group was all patients who had a TEM after macroscopically complete polypectomy for rectal cancer. Data covering an 11-year period were analysed. RESULTS Sixty three patients had TEM with no residual cancer after macroscopically complete polypectomy. Residual adenoma was found in 23 (37%). A postpolypectomy endoscopy had not detected the residual adenoma in three. Malignant local recurrence occurred in five patients (8%) and distant metastases in another two (3%). Recurrence occurred in 4/23 (17%) when there was residual adenoma in the TEM specimen and in 3/40 (7.5%) where there was scar only, although this did not reach significance. In two instances recurrence was around 10 years after TEM. Those with residual adenoma at TEM tended to have poorer survival. CONCLUSION Further local excision often reveals no residual cancer despite microscopically involved polypectomy margins. Careful endoscopy is required to assess the polypectomy site as residual tumour can be missed. In the absence of residual adenoma, TEM does not appear to be of benefit, although a small risk of recurrence exists.
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Affiliation(s)
- Helen J S Jones
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Issam Al-Najami
- Department of Surgery, Odense University Hospital, Odense, Denmark
| | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, Odense, Denmark
| | - Chris Cunningham
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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12
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Yeh JH, Tseng CH, Huang RY, Lin CW, Lee CT, Hsiao PJ, Wu TC, Kuo LT, Wang WL. Long-term Outcomes of Primary Endoscopic Resection vs Surgery for T1 Colorectal Cancer: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2020; 18:2813-2823.e5. [PMID: 32526343 DOI: 10.1016/j.cgh.2020.05.060] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS There is controversy over the best therapeutic approach for T1 colorectal cancer. We performed a systematic review and meta-analysis of long-term outcomes of endoscopic resection (ER) vs those of primary or additional surgery. METHODS We performed a systematic review of the PubMed, Embase, and Cochrane databases through October 2019 for studies that reported outcomes (overall survival, disease-specific survival, recurrence-free survival at 5 years, recurrence, and metastasis) of ER vs surgery in patients with colorectal neoplasms. Hazard ratios (HR) were calculated based on time to events. RESULTS In total, 17 published studies with 19,979 patients were included. The median follow-up time among the studies was 36 months. The meta-analysis found no significant differences between primary ER and primary surgery in overall survival (79.6% vs 82.1%, HR, 1.10; 95% CI, 0.84-1.45), recurrence-free survival (96.0% vs 96.7%, HR, 1.28; 95% CI, 0.87-1.88), or disease-specific survival (94.8% vs 96.5%; HR, 1.09; 95% CI, 0.67-1.78). Additional surgery and primary surgery did not produce significant differences in recurrence-free survival (HR, 1.27; 95% CI, 0.85-1.89). A significantly lower proportion of patients who underwent primary ER had procedure-related adverse events (2.3%) than patients who underwent primary surgery (10.9%) (P < .001). Lymphovascular invasion and rectal cancer, but not depth of submucosal invasion, were independently associated with recurrence for all T1 colorectal cancers. CONCLUSIONS In a systematic review and meta-analysis, we found that ER should be considered as the first-line treatment for endoscopically resectable T1 colorectal cancers. In cases of noncurative resection, additional surgery can have comparable outcomes to primary surgery.
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Affiliation(s)
- Jen-Hao Yeh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-Shou University, Da-Chung Branch, Kaohsiung, Taiwan
| | - Cheng-Hao Tseng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Cancer Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Ru-Yi Huang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Department of Family Medicine, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Chih-Wen Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-Shou University, Da-Chung Branch, Kaohsiung, Taiwan
| | - Ching-Tai Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Po-Jen Hsiao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-Shou University, Da-Chung Branch, Kaohsiung, Taiwan
| | - Tsung-Chin Wu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-Shou University, Da-Chung Branch, Kaohsiung, Taiwan
| | - Liang-Tseng Kuo
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia-Yi, College of Medicine, Chang Gung University, Chiayi, Taiwan
| | - Wen-Lun Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
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13
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Gijsbers K, de Graaf W, Moons LM, ter Borg F. High practice variation in risk stratification, baseline oncological staging, and follow-up strategies for T1 colorectal cancers in the Netherlands. Endosc Int Open 2020; 8:E1117-E1122. [PMID: 32904821 PMCID: PMC7458727 DOI: 10.1055/a-1192-3545] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Based on pathology, locally resected T1 colorectal cancer (T1-CRC) can be classified as having low- or high-risk for irradicality and/or lymph node metastasis, the latter requiring adjuvant surgery. Reporting and application of pathological high-risk criteria is likely variable, with inherited variation regarding baseline oncological staging, treatment and surveillance. Methods We assessed practice variation using an online survey among gastroenterologists and surgeons participating in the Dutch T1-CRC Working Group. Results Of the 130 invited physicians, 53 % participated. Regarding high-risk T1-CRC criteria, lymphangio-invasion is used by 100 %, positive or indeterminable margins by 93 %, poor differentiation by 90 %, tumor-free margin ≤ 1 mm by 78 %, tumor budding by 57 % and submucosal invasion > 1000 µm by 47 %. Fifty-two percent of the respondents do not perform baseline staging in locally resected low-risk T1-CRC. In case of unoperated high-risk patients, we recorded 61 different surveillance strategies in 63 participants, using 19 different combinations of diagnostic tests. Endoscopy is used in all schedules. Mean follow-up time is 36 months for endoscopy, 26 months for rectal MRI and 30 months for abdominal CT (all varying 3-60 months). Conclusion We found variable use of pathological high-risk T1-CRC criteria, creating risk for misclassification as low-risk T1-CRC. This has serious implications, as most participants will not proceed to oncological staging in low-risk patients and adjuvant surgery nor radiological surveillance is considered. On the other hand, oncological surveillance in patients with a locally resected high-risk T1-CRC who do not wish adjuvant surgery is highly variable emphasizing the need for a uniform surveillance protocol.
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Affiliation(s)
- Kim Gijsbers
- Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands,Department of Gastroenterology and Hepatology, UMC Utrecht, Utrecht, The Netherlands
| | - Wilmar de Graaf
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Leon M.G. Moons
- Department of Gastroenterology and Hepatology, UMC Utrecht, Utrecht, The Netherlands
| | - F. ter Borg
- Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands
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Hwang JH, Jamidar P, Kyanam Kabir Baig KR, Leung FW, Lightdale JR, Maranki JL, Okolo PI, Swanstrom LL, Chak A. GIE Editorial Board top 10 topics: advances in GI endoscopy in 2019. Gastrointest Endosc 2020; 92:241-251. [PMID: 32470427 DOI: 10.1016/j.gie.2020.05.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023]
Abstract
The American Society for Gastrointestinal Endoscopy's GIE Editorial Board reviewed original endoscopy-related articles published during 2019 in Gastrointestinal Endoscopy and 10 other leading medical and gastroenterology journals. Votes from each individual member were tallied to identify a consensus list of 10 topic areas of major advances in GI endoscopy. Individual board members summarized important findings published in these 10 areas of disinfection, artificial intelligence, bariatric endoscopy, adenoma detection, polypectomy, novel imaging, Barrett's esophagus, third space endoscopy, interventional EUS, and training. This document summarizes these "top 10" endoscopic advances of 2019.
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Affiliation(s)
- Joo Ha Hwang
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California
| | - Priya Jamidar
- Professor of Medicine, Yale University, New Haven, Connecticut
| | | | - Felix W Leung
- Veterans Affairs Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA
| | - Jennifer R Lightdale
- University of Massachusetts Medical School, Umass Memorial Childrens Medical Center, Worcester, Massachusetts
| | | | - Patrick I Okolo
- Executive Medical Director, Rochester Regional Health Systems, Rochester, NY
| | - Lee L Swanstrom
- Professor of Surgery, Oregon Health and Sciences University: Scientific Director and Chief Innovations Officer, Institutes Hospitalos Universitaires (IHU-Strasbourg) University of Strasbourg
| | - Amitabh Chak
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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15
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Park EY, Baek DH, Lee MW, Kim GH, Park DY, Song GA. Long-Term Outcomes of T1 Colorectal Cancer after Endoscopic Resection. J Clin Med 2020; 9:jcm9082451. [PMID: 32751830 PMCID: PMC7464364 DOI: 10.3390/jcm9082451] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 12/17/2022] Open
Abstract
Background and Aims: Endoscopic resection (ER) for submucosal invasive colorectal cancer (T1 CRC) can be grouped as curative ER (C-ER) and non-curative ER (NC-ER). Little is known about the long-term outcomes of patients in these two groups. Therefore, we have evaluated the long-term outcomes in endoscopically resected T1 CRC patients in C-ER and NC-ER groups. Methods: We conducted a retrospective study on 220 patients with T1 CRC treated with ER from January 2007 to December 2017. First, we investigated the long-term outcomes (5-year overall survival [OS] and recurrence-free survival [RFS]) in the C-ER group (n = 49). In the NC-ER group (n = 171), we compared long-term outcomes between patients who underwent additional surgical resection (ASR) (n = 117) and those who did not (surveillance-only, n = 54). Results: T1 CRC patients in the C-ER and NC-ER groups had a median follow-up of 44 (interquartile range 32–69) months. There was no risk of tumor recurrence and cancer-related deaths in patients with C-ER. In the NC-ER group, the 5-year OS rates were 75.3% and 92.6% in the surveillance-only and ASR subgroups, respectively. The hazard ratio (HR) for ASR in NC-ER vs. surveillance-only in NC-ER was statistically insignificant. However, RFS rates were significantly different between the ASR (97.2%) and surveillance-only (84.0%) subgroups. Multivariate analysis indicated a submucosal invasion depth (SID) of >2500 µm and margin positivity to be associated with recurrence. Conclusions: The surveillance-only approach can be considered as an alternative surgical option for T1 CRCs in selected patients undergoing NC-ER.
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Affiliation(s)
- Eun Young Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 49421, Korea; (E.Y.P.); (M.W.L.); (G.H.K.); (G.A.S.)
- Biomedical Research Institute, Pusan National University Hospital, Busan 49421, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 49421, Korea; (E.Y.P.); (M.W.L.); (G.H.K.); (G.A.S.)
- Biomedical Research Institute, Pusan National University Hospital, Busan 49421, Korea
- Correspondence: ; Tel.: +82-51-2407869; Fax: +82-51-2448180
| | - Moon Won Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 49421, Korea; (E.Y.P.); (M.W.L.); (G.H.K.); (G.A.S.)
- Biomedical Research Institute, Pusan National University Hospital, Busan 49421, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 49421, Korea; (E.Y.P.); (M.W.L.); (G.H.K.); (G.A.S.)
- Biomedical Research Institute, Pusan National University Hospital, Busan 49421, Korea
| | - Do Youn Park
- Biomedical Research Institute, Pusan National University Hospital, Busan 49421, Korea
- Department of Pathology, Pusan National University School of Medicine, Busan 49421, Korea;
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 49421, Korea; (E.Y.P.); (M.W.L.); (G.H.K.); (G.A.S.)
- Biomedical Research Institute, Pusan National University Hospital, Busan 49421, Korea
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Martínez Vila C, Oliveres Montero de Novoa H, Martínez-Bauer E, Serra-Aracil X, Mora L, Casalots-Casado A, Macías-Declara I, Pericay C. A real world analysis of recurrence risk factors for early colorectal cancer T1 treated with standard endoscopic resection. Int J Colorectal Dis 2020; 35:921-927. [PMID: 32146501 DOI: 10.1007/s00384-020-03553-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND STUDY AIM Currently, endoscopic resection of early colorectal cancer defined as carcinoma with limited invasion of the mucosa (Tis) and submucosa (T1) is possible. However, lymph node spreading increases to 16.2% of cases when tumor invades the submucosa. We analyzed the previously identified factors for lymph node dissemination and recurrence, in our population. PATIENTS AND METHODS We analyzed retrospectively all patients with T1 tumors, treated at our center with endoscopic resection and some with additional surgery between January 2006 and January 2018. Statistical analysis was performed using IBM SPSS Statistics 25.0. RESULTS One hundred fifty-nine patients were treated with endoscopic resection, 56.6% with additional surgery. The mean age was 68.74 years and 69. 9% were male. All patients who underwent additional surgery presented negative margins and 8.8% presented positive lymph nodes. In a mean follow-up of 23.36 months, 13 patients had relapsed. The risk of relapse did not differ between patients treated with additional surgery from those who only underwent endoscopic resection (p = 0.506). On the other hand, lymph node dissemination (p = 0.007) and a positive endoscopic margin (p = 0.01) were independent risk factors for relapse. There was a positive association between lymph node dissemination and lymphatic (p = 0.07), vascular (p = 0.007), and perineural (p = 0.001) invasion and also with degree of histological differentiation (p = 0.001). CONCLUSION In our study, lymphatic, vascular, and perineural invasion and also the degree of histological differentiation were associated with lymph node dissemination. However, the only independent risk factors for long-term recurrence were a positive margin and lymph node dissemination.
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Affiliation(s)
- C Martínez Vila
- Department of Medical Oncology, Corporació Sanitària Parc Taulí Sabadell, Parc del Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - H Oliveres Montero de Novoa
- Department of Medical Oncology, Corporació Sanitària Parc Taulí Sabadell, Parc del Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - E Martínez-Bauer
- Department of Digestology-Endoscopy, Corporació Sanitària Parc Taulí Sabadell, Parc del Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - X Serra-Aracil
- Department of Surgery, Corporació Sanitària Parc Taulí Sabadell, Parc del Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - L Mora
- Department of Surgery, Corporació Sanitària Parc Taulí Sabadell, Parc del Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - A Casalots-Casado
- Department of Pathology, Corporació Sanitària Parc Taulí Sabadell, Parc del Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - I Macías-Declara
- Department of Medical Oncology, Corporació Sanitària Parc Taulí Sabadell, Parc del Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - C Pericay
- Department of Medical Oncology, Corporació Sanitària Parc Taulí Sabadell, Parc del Taulí 1, 08208, Sabadell, Barcelona, Spain.
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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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Ketelaers SHJ, Fahim M, Rutten HJT, Smits AB, Orsini RG. When and how should surgery be performed in senior colorectal cancer patients? Eur J Surg Oncol 2020; 46:326-332. [PMID: 31955993 DOI: 10.1016/j.ejso.2020.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/03/2020] [Indexed: 12/28/2022] Open
Abstract
Older studies reported high rates of postoperative morbidity and mortality in the senior population, which lead to a tendency to withhold curative surgery in the older population. However, more recent studies showed impressing developments in postoperative outcomes in seniors. Probably, these improvements are due to enhancements in both surgical and non-surgical aspects in the pre-, peri- and postoperative period, such as minimally invasive techniques and anesthesiological insights. The postoperative survival gap seen earlier between younger and older patients is fading. For optimal treatment in the older population, special awareness and care on several aspects is needed. As only a minority of the seniors are frail, a quick frailty assessment is crucial to distinguish the fit from the frail in the decision-making process. In addition, it could be valuable to improve the lacks in physical condition in the preoperative period with the use of prehabilitation programs. Furthermore, it is important to evolve an emergency to an elective setting by postponing emergency surgery to prevent any high-risk situation. In conclusion, based on modern insights, surgery is a valid option in the curative treatment of colorectal cancer in seniors, however individual attention and care is required.
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Affiliation(s)
- S H J Ketelaers
- Department of Surgery, Catharina Hospital Eindhoven, the Netherlands.
| | - M Fahim
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - H J T Rutten
- Department of Surgery, Catharina Hospital Eindhoven, the Netherlands; GROW: School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands
| | - A B Smits
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - R G Orsini
- Department of Surgery, Catharina Hospital Eindhoven, the Netherlands
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Role of Endoscopic Resection Versus Surgical Resection in Management of Malignant Colon Polyps: a National Cancer Database Analysis. J Gastrointest Surg 2020; 24:177-187. [PMID: 31428961 DOI: 10.1007/s11605-019-04356-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 07/30/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic resection (polypectomy) or surgery, are the main approaches in management of malignant colon polyps. There are very few large population-based studies comparing outcomes between the two. METHODS Using the National Cancer Database, we identified patients ≥ 18 years with the first diagnosis of T1N0M0 malignant polyp from 2004 to 2015. Patients with a positive resection margin were excluded. Outcomes were compared between those who had surgery versus those who had polypectomy. Overall survival was compared using Kaplan-Meier curves. Multivariate Cox proportional hazards analysis was performed to generate hazard ratios, adjusted for patient, demographic, and tumor factors. RESULTS A total of 31,062 patients met the inclusion criteria, out of which 2593 (8.3%) underwent polypectomy alone and 28,469 (91.7%) had surgery. Overall survival was significantly better in the surgical group compared with the polypectomy group. One-year and 5-year survival for surgery were 95.8% and 86.1% respectively compared with 94.2% and 80.6% for polypectomy (p < .0001). Hazard ratio for surgery after adjusting for various clinical-, demographic-, and tumor-level factors was 0.53 (p < .0001). CONCLUSION Our study is the largest population-based analysis of patients with T1N0M0 malignant colon polyps. Overall survival was higher in patients who underwent surgery compared with polypectomy. This remained consistent even after adjusting for multiple patient and tumor factors between the two groups.
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Antonelli G, Vanella G, Orlando D, Angeletti S, Di Giulio E. Recurrence and cancer-specific mortality after endoscopic resection of low- and high-risk pT1 colorectal cancers: a meta-analysis. Gastrointest Endosc 2019; 90:559-569.e3. [PMID: 31175875 DOI: 10.1016/j.gie.2019.05.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/27/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Clinical management after complete endoscopic resection of pT1 colorectal cancers (CRCs) is still under debate. Follow-up data are heterogeneous and poorly reported, resulting in variable clinical management. Our aim was to meta-analyze recurrence and cancer-specific mortality (CSM) occurring after endoscopic resection of low- and high-risk pT1 CRCs undergoing conservative (nonsurgical) management. METHODS Literature was systematically searched until February 2019 for studies describing patients with pT1 CRCs, histologically classifiable as low or high risk, endoscopically resected without complementary surgery and with ≥12 months of follow-up. Pooled cumulative incidence (and incidence rate when specific follow-up intervals were available) of recurrence and CSM were calculated separately for low- and high-risk pT1 CRCs. Quality, publication bias, and heterogeneity were explored. RESULTS Pooled cumulative incidences of recurrence and CSM among high-risk lesions (5 studies, 571 patients) were, respectively, 9.5% (95% confidence interval [CI], 6.7%-13.3%; I2 = 38.4%) and 3.8% (95% CI, 2.4%-5.8%; I2 = 0%), whereas among low-risk lesions (7 studies, 650 patients) they were, respectively, 1.2% (95% CI, .6%-2.5%; I2 = 0%) and .6% (95% CI, .2%-1.7%; I2 = 0%). Pooled incidence rates of recurrence and CSM among high-risk lesions (3 cohorts, 237 patients) were, respectively, 11 (95% CI, 2-20; I2 = 43.3%) and 4 (95% CI, 1-7; I2 = 0%) per 1000 patient-years, whereas among low-risk lesions (3 cohorts, 229 patients) they were 3 (95% CI, 0-6; I2 = 0%) and 2 (95% CI, 0-4; I2 = 0%) per 1000 patient-years, respectively. No publication bias or significant heterogeneity was found. CONCLUSIONS Pooled estimates of adverse events after endoscopic resection of pT1 CRCs suggest a conservative approach for low-risk lesions. In high-risk lesions, increased surgical risk might justify a conservative management, whereas fitness for surgery makes surgical completion appropriate.
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Affiliation(s)
- Giulio Antonelli
- Endoscopy Unit, Sant 'Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppe Vanella
- Endoscopy Unit, Sant 'Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Davide Orlando
- Endoscopy Unit, Sant 'Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Stefano Angeletti
- Endoscopy Unit, Sant 'Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Emilio Di Giulio
- Endoscopy Unit, Sant 'Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy
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Surgery Versus Endoscopic Mucosal Resection Versus Endoscopic Submucosal Dissection for Large Polyps: Making Sense of When to Use Which Approach. Gastrointest Endosc Clin N Am 2019; 29:675-685. [PMID: 31445690 DOI: 10.1016/j.giec.2019.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Endoscopic resection for large colorectal lesion is effective and cost-saving than surgery. Piecemeal resections are often effective if applied meticulously but endoscopic submucosal dissection (ESD) allows meritorious removal of large lesions in one piece. For rectal lesions, transanal endoscopic microsurgery or transanal minimally invasive surgery offers more radical transmural resection but ESD is also effective for removal of complex rectal lesions. Surgical resection with lymph node dissection is the gold standard for invasive cancer; however, the management of low-risk early-stage colorectal cancer is worth debating. Treatment selection for large colorectal lesions is discussed based on lesion factor and treatment outcomes.
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Prognostic significance of resident CD103 +CD8 +T cells in human colorectal cancer tissues. Acta Histochem 2019; 121:657-663. [PMID: 31153587 DOI: 10.1016/j.acthis.2019.05.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/07/2019] [Accepted: 05/22/2019] [Indexed: 02/07/2023]
Abstract
The prognostic significance and clinical implications of resident CD103+CD8+T cells in human colorectal cancer tissues still remains largely unexplored. In our present study, we aimed to characterize the resident CD8+T cells in human colorectal cancer tissues by using double staining of CD103 and CD8, and further evaluated the prognostic significance of resident CD8+T cells in colorectal cancer. We found that the OS rate of the colorectal cancer patients with higher infiltration of CD8+T cells, or with higher numbers of resident CD103+CD8+T cells, or with higher ratio of CD103+CD8+T cells over total CD8+T cells in cancer tissues was significantly better than that of the patients with lower infiltration of CD8+T cells, or with lower numbers of resident CD103+CD8+T cells, or with higher ratio of CD103+CD8+T cells over total CD8+T cells in cancer tissues, respectively. Moreover, higher infiltration of CD8+T cells in colorectal cancer tissues was significantly and inversely correlated with advanced TNM stage. Higher numbers of resident CD103+CD8+T cells in colorectal cancer tissues were significantly and inversely correlated with distant metastasis status. Higher ratio of CD103+CD8+T cells over total CD8+T cells in colorectal cancer tissues was significantly and inversely correlated with age status. The COX model analysis demonstrated that higher infiltration of CD8+T cells, higher numbers of resident CD103+CD8+T cells, or higher ratio of CD103+CD8+T cells over total CD8+T cells in colorectal cancer tissues, could serve as independent prognostic predictors for colorectal cancer patients. Taken together, our present study demonstrated the density of tumor infiltrating CD8+T cells or the numbers of resident CD103+CD8+T cells in colorectal tissues could be used as an important prognostic predictor for this malignancy.
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Rampioni Vinciguerra GL, Antonelli G, Citron F, Berardi G, Angeletti S, Baldassarre G, Vecchione A, Di Giulio E, Pilozzi E. Pathologist second opinion significantly alters clinical management of pT1 endoscopically resected colorectal cancer. Virchows Arch 2019; 475:665-668. [PMID: 31209636 DOI: 10.1007/s00428-019-02603-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/31/2019] [Accepted: 06/06/2019] [Indexed: 12/17/2022]
Abstract
We retrospectively collected a series of 82 endoscopically removed early colorectal cancers. Histological specimens were revised by two gastrointestinal pathologists, performing a re-evaluation of all risk factors for lymph node metastasis. The comparison between second opinion and first pathological report revealed that lymphovascular invasion and tumor grading showed a lower level of concordance than other parameters. Our results demonstrated that second opinion modified risk assessment in about 10% of cases. It was mainly due to a lack in reporting of some parameters at the first diagnosis and a different evaluation in second opinion for updated guidelines. Considering the subgroup of patients with modified risk assessment, clinical data revealed that tumors, re-classified as low risk, did not develop lymph node metastasis that, conversely, occurred in patients identified as high risk by second opinion. In conclusion, second opinion significantly alters risk perception of endoscopically removed early colorectal carcinomas representing a valuable tool for their appropriate clinical management.
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Affiliation(s)
- Gian Luca Rampioni Vinciguerra
- Faculty of Medicine and Psychology, Department of Clinical and Molecular Medicine, University of Rome "Sapienza", Santo Andrea Hospital, via di Grottarossa 1035, 00189, Rome, Italy.
- Division of Molecular Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, National Cancer Institute, 33081, Aviano, Italy.
| | - Giulio Antonelli
- Faculty of Medicine and Psychology, Department of Surgical and Medical Sciences and Translational Medicine, University of Rome "Sapienza", Santo Andrea Hospital, 00189, Rome, Italy
| | - Francesca Citron
- Division of Molecular Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, National Cancer Institute, 33081, Aviano, Italy
| | - Giammauro Berardi
- Faculty of Medicine and Psychology, Department of Surgical and Medical Sciences and Translational Medicine, University of Rome "Sapienza", Santo Andrea Hospital, 00189, Rome, Italy
| | - Stefano Angeletti
- Faculty of Medicine and Psychology, Department of Surgical and Medical Sciences and Translational Medicine, University of Rome "Sapienza", Santo Andrea Hospital, 00189, Rome, Italy
| | - Gustavo Baldassarre
- Division of Molecular Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, National Cancer Institute, 33081, Aviano, Italy
| | - Andrea Vecchione
- Faculty of Medicine and Psychology, Department of Clinical and Molecular Medicine, University of Rome "Sapienza", Santo Andrea Hospital, via di Grottarossa 1035, 00189, Rome, Italy
| | - Emilio Di Giulio
- Faculty of Medicine and Psychology, Department of Surgical and Medical Sciences and Translational Medicine, University of Rome "Sapienza", Santo Andrea Hospital, 00189, Rome, Italy
| | - Emanuela Pilozzi
- Faculty of Medicine and Psychology, Department of Clinical and Molecular Medicine, University of Rome "Sapienza", Santo Andrea Hospital, via di Grottarossa 1035, 00189, Rome, Italy
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Kessels K, Backes Y, Elias SG, van den Blink A, Offerhaus GJA, van Bergeijk JD, Groen JN, Seerden TCJ, Schwartz MP, de Vos Tot Nederveen Cappel WH, Spanier BWM, Geesing JMJ, Kerkhof M, Siersema PD, Didden P, Boonstra JJ, Herrero LA, Wolfhagen FHJ, Ter Borg F, van Lent AU, Terhaar Sive Droste JS, Hazen WL, Schrauwen RWM, Vleggaar FP, Laclé MM, Moons LMG. Pedunculated Morphology of T1 Colorectal Tumors Associates With Reduced Risk of Adverse Outcome. Clin Gastroenterol Hepatol 2019; 17:1112-1120.e1. [PMID: 30130623 DOI: 10.1016/j.cgh.2018.08.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Risk stratification for adverse events, such as metastasis to lymph nodes, is based only on histologic features of tumors. We aimed to compare adverse outcomes of pedunculated vs nonpedunculated T1 colorectal cancers (CRC). METHODS We performed a retrospective study of 1656 patients diagnosed with T1CRC from 2000 through 2014 at 14 hospitals in The Netherlands. The median follow-up time of patients was 42.5 months (interquartile range, 18.5-77.5 mo). We evaluated the association between tumor morphology and the primary composite end point, adverse outcome, adjusted for clinical variables, histologic variables, resection margins, and treatment approach. Adverse outcome was defined as metastasis to lymph nodes, distant metastases, local recurrence, or residual tissue. Secondary end points were tumor metastasis, recurrence, and incomplete resection. RESULTS Adverse outcome occurred in 67 of 723 patients (9.3%) with pedunculated T1CRCs vs 155 of 933 patients (16.6%) with nonpedunculated T1CRCs. Pedunculated morphology was independently associated with decreased risk of adverse outcome (adjusted odds ratio [OR], 0.59; 95% CI, 0.42-0.83; P = .003). Metastasis, incomplete resection, and recurrence were observed in 5.8%, 4.6%, and 3.9% of pedunculated T1CRCs vs 10.6%, 8.0%, and 6.6% of nonpedunculated T1CRCs, respectively. Pedunculated morphology was independently associated with a reduced risk of metastasis (adjusted OR, 0.62; 95% CI, 0.41-0.94; P = .03), incomplete resection (adjusted OR, 0.57; 95% CI, 0.36-0.91; P = .02), and recurrence (adjusted hazard ratio, 0.52; 95% CI, 0.32-0.85; P = .009). Metastasis, incomplete resection, and recurrence did not differ significantly between low-risk pedunculated vs nonpedunculated T1CRCs (0.8% vs 2.9%, P = .38; 1.5% vs 0%, P = .99; 1.5% vs 0%; P = .99). However, incomplete resection and recurrence were significantly lower for high-risk pedunculated vs nonpedunculated T1CRCs (6.5% vs 12.5%; P = .007; 4.4% vs 8.6%; P = .03). CONCLUSIONS In a retrospective study of patients with T1CRC, we found pedunculated morphology to be associated independently with a decreased risk of adverse outcome in a T1CRC population at high risk of adverse outcome. Incorporating morphologic features of tumors in risk assessment could help predict outcomes of patients with T1CRC and help identify the best candidates for surgery.
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Affiliation(s)
- Koen Kessels
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Yara Backes
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Aneya van den Blink
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Critical Care Medicine, Vrije Universiteit University Medical Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - G Johan A Offerhaus
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jeroen D van Bergeijk
- Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands
| | - John N Groen
- Department of Gastroenterology and Hepatology, Sint Jansdal Hospital, Harderwijk, The Netherlands
| | - Tom C J Seerden
- Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands
| | - Matthijs P Schwartz
- Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands
| | | | - Bernhard W M Spanier
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Joost M J Geesing
- Department of Gastroenterology and Hepatology, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Marjon Kerkhof
- Department of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Gastroenterology and Hepatology, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands
| | - Paul Didden
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jurjen J Boonstra
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Lorenza Alvarez Herrero
- Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Frank H J Wolfhagen
- Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Frank Ter Borg
- Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands
| | - Anja U van Lent
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, The Netherlands
| | | | - Wouter L Hazen
- Department of Gastroenterology and Hepatology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Ruud W M Schrauwen
- Department of Gastroenterology and Hepatology, Bernhoven Hospital, Uden, The Netherlands
| | - Frank P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Miangela M Laclé
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Leon M G Moons
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
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Ciocalteu A, Gheonea DI, Saftoiu A, Streba L, Dragoescu NA, Tenea-Cojan TS. Current strategies for malignant pedunculated colorectal polyps. World J Gastrointest Oncol 2018; 10:465-475. [PMID: 30595800 PMCID: PMC6304302 DOI: 10.4251/wjgo.v10.i12.465] [Citation(s) in RCA: 16] [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: 09/27/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 02/05/2023] Open
Abstract
Despite significant advances in imaging techniques, the incidence of colorectal cancer has been increasing in recent years, with many cases still being diagnosed in advanced stages. Early detection and accurate staging remain the main factors that lead to a decrease in the cost and invasiveness of the curative techniques, significantly improving the outcome. However, the diagnosis of pedunculated early colorectal malignancy remains a current challenge. Data on the management of pedunculated cancer precursors, apart from data on nonpolypoid lesions, are still limited. An adequate technique for complete resection, which provides the best long-term outcome, is mandatory for curative intent. In this context, a discussion regarding the diagnosis of malignancy of pedunculated polyps, separate from non-pedunculated variants, is necessary. The purpose of this review is to provide a critical review of the most recent literature reporting the different features of malignant pedunculated colorectal polyps, including diagnosis and management strategies.
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Affiliation(s)
- Adriana Ciocalteu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Dan Ionut Gheonea
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Liliana Streba
- Department of Oncology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Nicoleta Alice Dragoescu
- Department of Anesthesiology and Intensive Care, Emergency County Hospital of Craiova, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Tiberiu Stefanita Tenea-Cojan
- Department of General Surgery, C.F. Clinical Hospital, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
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Antonelli G, Berardi G, Rampioni Vinciguerra GL, Brescia A, Ruggeri M, Mercantini P, Corleto VD, D’Ambra G, Pilozzi E, Hassan C, Angeletti S, Di Giulio E. Clinical management of endoscopically resected pT1 colorectal cancer. Endosc Int Open 2018; 6:E1462-E1469. [PMID: 30574536 PMCID: PMC6291400 DOI: 10.1055/a-0781-2293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/14/2018] [Indexed: 02/06/2023] Open
Abstract
Background Implementation of colorectal cancer (CRC) screening programs increases endoscopic resection of polyps with early invasive CRC (pT1). Risk of lymph node metastasis often leads to additional surgery, but despite guidelines, correct management remains unclear. Our aim was to assess the factors affecting the decision-making process in endoscopically resected pT1-CRCs in an academic center. Methods We retrospectively reviewed patients undergoing endoscopic resection of pT1 CRC from 2006 to 2016. Clinical, endoscopic, surgical treatment, and follow-up data were collected and analyzed. Lesions were categorized according to endoscopic/histological risk-factors into low and high risk groups. Comorbidities were classified according to the Charlson comorbidity index (CCI). Surgical referral for each group was computed, and dissociation from current European CRC screening guidelines recorded. Multivariate analysis for factors affecting the post-endoscopic surgery referral was performed. Results Seventy-two patients with endoscopically resected pT1-CRC were included. Overall, 20 (27.7 %) and 52 (72.3 %) were classified as low and high risk, respectively. In the low risk group, 11 (55 %) were referred to surgery, representing over-treatment compared with current guidelines. In the high risk group, nonsurgical endoscopic surveillance was performed in 20 (38.5 %) cases, representing potential under-treatment. After a median follow-up of 30 (6 - 130) months, no patients developed tumor recurrence. At multivariate analysis, age (OR 1.21, 95 %CI 1.02 - 1.42; P = 0.02) and CCI (OR 1.67, 95 %CI 1.12 - 3.14; P = 0.04) were independent predictors for subsequent surgery. Conclusions A substantial rate of inappropriate post-endoscopic treatment of pT1-CRC was observed when compared with current guidelines. This was apparently related to an overestimation of patient-related factors rather than endoscopically or histologically related factors.
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Affiliation(s)
- Giulio Antonelli
- Endoscopy Unit, Azienda Ospedaliera Sant’Andrea, “Sapienza” University of Rome, Rome, Italy,Corresponding author Giulio Antonelli, MD Digestive Endoscopy UnitSant’Andrea Hospital“Sapienza” University of RomeVia di Grottarossa 1035-103900189RomeItaly+39-06-33776692
| | - Giammauro Berardi
- General Surgery Unit, Azienda Ospedaliera Sant’Andrea, “Sapienza” University of Rome, Rome, Italy
| | | | - Antonio Brescia
- General Surgery Unit, Azienda Ospedaliera Sant’Andrea, “Sapienza” University of Rome, Rome, Italy
| | - Maurizio Ruggeri
- Endoscopy Unit, Azienda Ospedaliera Sant’Andrea, “Sapienza” University of Rome, Rome, Italy
| | - Paolo Mercantini
- General Surgery Unit, Azienda Ospedaliera Sant’Andrea, “Sapienza” University of Rome, Rome, Italy
| | - Vito Domenico Corleto
- Endoscopy Unit, Azienda Ospedaliera Sant’Andrea, “Sapienza” University of Rome, Rome, Italy
| | - Giancarlo D’Ambra
- Endoscopy Unit, Azienda Ospedaliera Sant’Andrea, “Sapienza” University of Rome, Rome, Italy
| | - Emanuela Pilozzi
- Pathology Unit, Azienda Ospedaliera Sant’Andrea, “Sapienza” University of Rome, Rome, Italy
| | - Cesare Hassan
- Endoscopy Unit, Azienda Ospedaliera Sant’Andrea, “Sapienza” University of Rome, Rome, Italy
| | - Stefano Angeletti
- Endoscopy Unit, Azienda Ospedaliera Sant’Andrea, “Sapienza” University of Rome, Rome, Italy
| | - Emilio Di Giulio
- Endoscopy Unit, Azienda Ospedaliera Sant’Andrea, “Sapienza” University of Rome, Rome, Italy
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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: 15] [Impact Index Per Article: 2.1] [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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