scholarly journals The risk of lymph node metastasis makes it unsafe to expand the conventional indications for endoscopic treatment of T1 colorectal cancer

Medicine ◽  
2016 ◽  
Vol 95 (37) ◽  
pp. e4373 ◽  
Author(s):  
Bun Kim ◽  
Eun Hye Kim ◽  
Soo Jung Park ◽  
Jae Hee Cheon ◽  
Tae Il Kim ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Endoscopic Treatment ◽  
Node Metastasis ◽  
T1 Colorectal Cancer

Tumor Budding and Pathological Differentiation Are Predictive Markers for Lymph Node Metastasis in T1 Colorectal Cancer

2006 ◽  
Vol 63 (5) ◽  
pp. AB216 ◽  
Author(s):  
Hitoshi Yamauchi ◽  
Kazutomo Togashi ◽  
Hiroshi Kawamura ◽  
Junichi Sasaki ◽  
Masaki Okada ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Predictive Markers ◽  
Tumor Budding ◽  
Node Metastasis ◽  
Pathological Differentiation ◽  
T1 Colorectal Cancer

scholarly journals Tumour–stroma ratio has poor prognostic value in non-pedunculated T1 colorectal cancer: A multi-centre case-cohort study

2020 ◽  
pp. 205064062097532
Author(s):  
Hao Dang ◽  
Gabi W van Pelt ◽  
Krijn JC Haasnoot ◽  
Yara Backes ◽  
Sjoerd G Elias ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Prognostic Value ◽  
Adverse Outcome ◽  
Advanced Stage ◽  
Tumour Stroma ◽  
Node Metastasis ◽  
Increased Risk ◽  
T1 Colorectal Cancer

Background Current risk stratification models for early invasive (T1) colorectal cancer are not able to discriminate accurately between prognostic favourable and unfavourable tumours, resulting in over-treatment of a large (>80%) proportion of T1 colorectal cancer patients. The tumour–stroma ratio (TSR), which is a measure for the relative amount of desmoplastic tumour stroma, is reported to be a strong independent prognostic factor in advanced-stage colorectal cancer, with a high stromal content being associated with worse prognosis and survival. We aimed to investigate whether the TSR predicts clinical outcome in patients with non-pedunculated T1 colorectal cancer. Methods Hematoxylin and eosin (H&E)-stained tumour tissue slides from a retrospective multi-centre case cohort of patients with non-pedunculated surgically treated T1 colorectal cancer were assessed for TSR by two independent observers who were blinded for clinical outcomes. The primary end point was adverse outcome, which was defined as the presence of lymph node metastasis in the resection specimen or colorectal cancer recurrence during follow-up. Results All 261 patients in the case cohort had H&E slides available for TSR scoring. Of these, 183 were scored as stroma-low, and 78 were scored as stroma-high. There was moderate inter-observer agreement (κ = 0.42). In total, 41 patients had lymph node metastasis, 17 patients had recurrent cancer and five had both. Stroma-high tumours were not associated with an increased risk for an adverse outcome (adjusted hazard ratio = 0.66, 95% confidence interval 0.37–1.18; p = 0.163). Conclusions Our study emphasises that existing prognosticators may not be simply extrapolated to T1 colorectal cancers, even though their prognostic value has been widely validated in more advanced-stage tumours.

scholarly journals Predictive relevance of lymphovascular invasion in T1 colorectal cancer before endoscopic treatment

2017 ◽  
Vol 05 (12) ◽  
pp. E1278-E1283 ◽  
Author(s):  
Kazuya Inoki ◽  
Taku Sakamoto ◽  
Hiroyuki Takamaru ◽  
Masau Sekiguchi ◽  
Masayoshi Yamada ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Endoscopic Treatment ◽  
Lymphovascular Invasion ◽  
Lesion Size ◽  
Depth Of Invasion ◽  
Predictive Risk Factor ◽  
Node Metastasis ◽  
Younger Age

Abstract Background and aim The depth of tumor invasion is currently the only reliable predictive risk factor for lymph node metastasis before endoscopic treatment for colorectal cancer. However, the most important factor to predict lymph node metastasis has been suggested to be lymphovascular invasion rather than the depth of invasion. Thus, the aim of this study was to investigate the predictive relevance of lymphovascular invasion before endoscopic treatment. Methods The data on pT1 colorectal cancers that were resected endoscopically or surgically from 2007 to 2015 were retrospectively reviewed. The cases were categorized into two groups: positive or negative for lymphovascular invasion. The following factors were evaluated by univariate and multivariate analyses: age and sex of the patients; location, size, and morphology of the lesion; and depth of invasion. Results The positive and negative groups included 229 and 457 cases, respectively. Younger age (P < 0.01), smaller lesion size (P = 0.01), non-LST (LST: laterally spreading tumor) (P < 0.01), presence of depression (P < 0.01), and pT1b (P < 0.01) were associated with lymphovascular invasion. In multivariate analysis, younger age (comparing patients aged ≤ 64 years with those aged > 65 years, OR, 1.81; 95 %CI, 1.29 – 2.53), presence of depression (OR, 1.97; CI, 1.40 – 2.77), non-LST features (OR, 1.50; CI, 1.04 – 2.15), and pT1b (OR, 3.08; CI, 1.91 – 4.97) were associated with lymphovascular invasion. Conclusion Younger age, presence of depression, T1b, and non-LST are associated with lymphovascular invasion. Therefore, careful pathological diagnosis and surveillance are necessary for lesions demonstrating any of these four factors.

Does Additional Laparoscopic-Assisted Surgery after Endoscopic Submucosal Dissection Affect Short Outcomes in Patients with Stage T1 Colorectal Cancer? A Propensity Score-Based Analysis

2021 ◽  
pp. 1-7
Author(s):  
Pu Cheng ◽  
Zhao Lu ◽  
Fei Huang ◽  
Mingguang Zhang ◽  
Haipeng Chen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Endoscopic Submucosal Dissection ◽  
Hospital Stay ◽  
Node Metastasis ◽  
Submucosal Dissection ◽  
Additional Surgery ◽  
T1 Colorectal Cancer ◽  
Laparoscopic Assisted

<b><i>Background:</i></b> Additional surgery is necessary in cases with non-curative endoscopic submucosal dissection. It is still unknown whether preceding endoscopic submucosal dissection (ESD) for T1 colorectal carcinoma affects the short outcomes of patients who underwent additional surgery or not as compared with surgery alone without ESD. <b><i>Methods:</i></b> Patients (101 pairs) with T1 colorectal cancer who underwent additional laparoscopic-assisted surgery after endoscopic submucosal dissection (additional surgery group, <i>n</i> = 101) or laparoscopic-assisted surgery alone (surgery alone group, <i>n</i> = 101) were matched (1:1). Short-term morbidity, operation outcomes, and lymph node metastasis of the resected specimen were compared. <b><i>Results:</i></b> There were no significant differences between the additional laparoscopic-assisted surgery and laparoscopic-assisted surgery alone groups in lymph node metastasis (9.9 vs. 5.9%, respectively, <i>p</i> = 0.297), operative time (147.76 ± 52.00 min vs. 156.50 ± 54.28 min, <i>p</i> = 0.205), first flatus time (3.56 ± 1.10 days vs. 3.63 ± 1.05 days, <i>p</i> = 0.282), first stool time (4.30 ± 1.04 days vs. 4.39 ± 1.22 days, <i>p</i> = 0.293), time to intake (5.00 ± 1.18 days vs. 5.25 ± 1.39 days, <i>p</i> = 0.079), blood loss (44.75 ± 45.40 mL vs. 60.40 ± 78.98 mL, <i>p</i> = 0.603), harvest lymph nodes (18.74 ± 7.22 vs. 20.32 ± 9.69, <i>p</i> = 0.438), postoperative surgical complications (<i>p</i> = 0.733), and postoperative length of hospital stay (8.68 ± 4.00 days vs. 8.39 ± 1.94 days, <i>p</i> = 0.401). <b><i>Conclusion:</i></b> ESD did not increase the difficulty of additional laparoscopic-assisted surgery, hospital stay, or the incidence of postoperative complications. Additional laparoscopic-assisted surgery is safe and recommended for patients with T1 cancer at high risk of lymph node metastasis and residual cancer after non-curative ESD.

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