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

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

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

Sa1158 Outcomes of Management of Positive Resection Margins After Endoscopic Resection of Early Colorectal Cancer

2016 ◽  
Vol 83 (5) ◽  
pp. AB234-AB235
Author(s):  
Hyun Gun Kim ◽  
Seong-Ran Jeon ◽  
Jun-Hyung Cho ◽  
Bong Min Ko ◽  
Jin Oh Kim ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Endoscopic Resection ◽  
Early Colorectal Cancer ◽  
Resection Margins ◽  
Positive Resection Margins

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

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

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

scholarly journals Quantifying the influence of mutation detection on tumour subclonal reconstruction

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Lydia Y. Liu ◽  
Vinayak Bhandari ◽  
Adriana Salcedo ◽  
Shadrielle M. G. Espiritu ◽  
Quaid D. Morris ◽  
...  
Keyword(s):  
Whole Genome Sequencing ◽  
Cancer Cells ◽  
Clinical Outcomes ◽  
Cancer Cell ◽  
Genome Sequencing ◽  
Somatic Mutations ◽  
Mutation Detection ◽  
Cell Populations ◽  
Whole Genome ◽  
Prostate Cancers

AbstractWhole-genome sequencing can be used to estimate subclonal populations in tumours and this intra-tumoural heterogeneity is linked to clinical outcomes. Many algorithms have been developed for subclonal reconstruction, but their variabilities and consistencies are largely unknown. We evaluate sixteen pipelines for reconstructing the evolutionary histories of 293 localized prostate cancers from single samples, and eighteen pipelines for the reconstruction of 10 tumours with multi-region sampling. We show that predictions of subclonal architecture and timing of somatic mutations vary extensively across pipelines. Pipelines show consistent types of biases, with those incorporating SomaticSniper and Battenberg preferentially predicting homogenous cancer cell populations and those using MuTect tending to predict multiple populations of cancer cells. Subclonal reconstructions using multi-region sampling confirm that single-sample reconstructions systematically underestimate intra-tumoural heterogeneity, predicting on average fewer than half of the cancer cell populations identified by multi-region sequencing. Overall, these biases suggest caution in interpreting specific architectures and subclonal variants.

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

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

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

scholarly journals Quantifying the Influence of Mutation Detection on Tumour Subclonal Reconstruction

2018 ◽  
Author(s):  
Lydia Y. Liu ◽  
Vinayak Bhandari ◽  
Adriana Salcedo ◽  
Shadrielle M. G. Espiritu ◽  
Quaid D. Morris ◽  
...  
Keyword(s):  
Whole Genome Sequencing ◽  
Cancer Cells ◽  
Clinical Outcomes ◽  
Cancer Cell ◽  
Genome Sequencing ◽  
Somatic Mutations ◽  
Mutation Detection ◽  
Cell Populations ◽  
Whole Genome ◽  
Prostate Cancers

AbstractWhole-genome sequencing can be used to estimate subclonal populations in tumours and this intra-tumoural heterogeneity is linked to clinical outcomes. Many algorithms have been developed for subclonal reconstruction, but their variabilities and consistencies are largely unknown. We evaluated sixteen pipelines for reconstructing the evolutionary histories of 293 localized prostate cancers from single samples, and eighteen pipelines for the reconstruction of 10 tumours with multi-region sampling. We show that predictions of subclonal architecture and timing of somatic mutations vary extensively across pipelines. Pipelines show consistent types of biases, with those incorporating SomaticSniper and Battenberg preferentially predicting homogenous cancer cell populations and those using MuTect tending to predict multiple populations of cancer cells. Subclonal reconstructions using multi-region sampling confirm that single-sample reconstructions systematically underestimate intra-tumoural heterogeneity, predicting on average fewer than half of the cancer cell populations identified by multi-region sequencing. Overall, these biases suggest caution in interpreting specific architectures and subclonal variants.

Radiotherapy for intrahepatic cholangiocarcinoma: An analysis of the National Cancer Database.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 379-379
Author(s):  
Abdulrahman Y Hammad ◽  
George Younan ◽  
Rahul Rajeev ◽  
Nicholas Gerard Berger ◽  
Kiran Turaga ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Intrahepatic Cholangiocarcinoma ◽  
Resection Margin ◽  
Early Stage ◽  
Disease Stage ◽  
Resection Margins ◽  
National Cancer Database ◽  
Kaplan Meier ◽  
Positive Resection Margins ◽  
The Impact

379 Background: The role of radiotherapy (RT) for surgically resected intrahepatic cholangiocarcinoma (ICC) remains poorly defined. Radiotherapy is often considered when a positive resection margin exists. The present study sought to examine the impact of radiotherapy following liver resection. Methods: Patients with early stage ICC, who underwent surgical resection, were identified from the National Cancer Database (1998-2011). Patients were stratified by resection margin status and receipt of RT. Survival was analyzed by Kaplan-Meier method and a multivariate regression model was used to identify predictors of survival. Results: A total of 2,182 patients were identified. R0 status was obtained in 1,624 patients (74.4%). RT was delivered to 405 patients (R0=209, R1/R2=196). In the R1/R2 group, 196 patients received RT vs. 362 R1/R2 patients that did not receive RT. Survival for R0 vs. R1/R2 was 32m vs. 16.5m (p<0.001). RT appeared to trend toward improving survival for R1/R2 patients, though this was not significant (20.4m vs. 14.5m, p=0.191). In a multivariate model accounting for age, sex, comorbidities, disease stage and resection margins, RT was not a predictor of survival. Negative predictors of survival included age>65years (Hazards Ratio [HR]: 1.20 (95%CI: 1.04-1.39), p=0.013), and positive resection margins (HR: 1.95 (95%CI: 1.65-2.30), p<0.001). Female sex was the only positive predictor of survival identified (HR: 0.76 (95%CI: 0.65 -0.88), p<0.001). Conclusions: Surgical resection with negative margins provides the best outcome for patients with ICC. Radiotherapy does not appear to significantly impact survival in patients with positive resection margins.

Impact of proximal resection margin involvement on survival outcome in patients with proximal gastric cancer

2019 ◽  
Vol 73 (8) ◽  
pp. 470-475
Author(s):  
Bochao Zhao ◽  
Huiwen Lu ◽  
Shiyang Bao ◽  
Rui Luo ◽  
Di Mei ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymphovascular Invasion ◽  
Resection Margin ◽  
Survival Outcome ◽  
Resection Margins ◽  
Serosal Invasion ◽  
Proximal Gastric Cancer ◽  
Margin Involvement ◽  
Positive Resection Margins ◽  
Proximal Resection Margin

AimThe aim of this study was to evaluate the risk factors for proximal resection margin involvement and its impact on survival outcome in patients with proximal gastric cancer.MethodsA total of 488 patients who underwent potentially curative resection for proximal gastric cancer were retrospectively reviewed. Clinicopathological characteristics and survival differences between patients with positive and negative resection margins were compared and prognostic factors were determined by Cox multivariate analysis.ResultsIn this study, 7.6% (37/488) of patients with proximal gastric cancer had a positive proximal resection margin after postoperative histopathological examination. Positive resection margins were significantly associated with advanced tumour stage and more aggressive biological features including larger tumour size, serosal invasion and lymphovascular invasion. Serosal invasion (OR 4.543, 95% CI 2.201 to 9.380, p<0.001) and lymphovascular invasion (OR 2.279, 95% CI 1.129 to 4.600, p<0.05) were independent risk factors for positive proximal resection margins. In terms of survival outcome, positive resection margins had an adverse impact on the prognosis of patients with proximal gastric cancer (median DFS: 20.7 vs 30.2 months, p<0.001). The multivariate analysis indicated that positive resection margins (HR 1.494, 95% CI 1.042 to 2.142, p=0.029), T stage (T3–T4, HR 2.264, 95% CI 1.484 to 3.454, p<0.001) and N stage (N1–N2 stage, HR 1.696, 95% CI 1.279 to 2.248, p<0.001; N3 stage, HR 2.691, 95% CI 1.967 to 3.681, p<0.001) were independent prognostic factors for patients with proximal gastric cancer.ConclusionProximal resection margin involvement was an indicator of more aggressive tumours and an independent prognostic factor for patients with proximal gastric cancer. Aggressive efforts should be made to achieve a negative resection margin if gastric cancer was deemed to be potentially resectable.

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