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Outcomes of noncurative endoscopic submucosal dissection for T1 colorectal cancer: Prospective, multicenter, cohort study in Japan.
Tsuji, Shigetsugu; Doyama, Hisashi; Kobayashi, Nozomu; Ohata, Ken; Takeuchi, Yoji; Chino, Akiko; Takamaru, Hiroyuki; Tsuji, Yosuke; Hotta, Kinichi; Harada, Keita; Ikematsu, Hiroaki; Uraoka, Toshio; Murakami, Takashi; Katagiri, Atsushi; Hori, Shinichiro; Michida, Tomoki; Suzuki, Takuto; Fukuzawa, Masakatsu; Kiriyama, Shinsuke; Fukase, Kazutoshi; Murakami, Yoshitaka; Ishikawa, Hideki; Saito, Yutaka.
Afiliación
  • Tsuji S; Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan.
  • Doyama H; Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan.
  • Kobayashi N; Department of Gastroenterology, Tochigi Cancer Center, Tochigi, Japan.
  • Ohata K; Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
  • Takeuchi Y; Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan.
  • Chino A; Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
  • Takamaru H; Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan.
  • Tsuji Y; Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
  • Hotta K; Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
  • Harada K; Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Ikematsu H; Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.
  • Uraoka T; Department of Gastroenterology, Okayama University Hospital, Okayama, Japan.
  • Murakami T; Department of Gastroenterology, Okayama Saiseikai General Hospital, Okayama, Japan.
  • Katagiri A; Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan.
  • Hori S; Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.
  • Michida T; Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan.
  • Suzuki T; Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
  • Fukuzawa M; Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
  • Kiriyama S; Department of Gastroenterology, NHO Shikoku Cancer Center, Ehime, Japan.
  • Fukase K; Department of Gastrointestinal Medicine, Japan Red Cross Society Himeji Hospital, Hyogo, Japan.
  • Murakami Y; Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
  • Ishikawa H; Department of Internal Medicine, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan.
  • Saito Y; Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan.
Dig Endosc ; 2024 Aug 08.
Article en En | MEDLINE | ID: mdl-39117368
ABSTRACT

OBJECTIVES:

This study investigated the incidence of lymph node metastasis and long-term outcomes in patients with T1 colorectal cancer where endoscopic submucosal dissection (ESD) resulted in noncurative treatment. It is focused on those with deep submucosal invasion, a factor considered a weak predictor of lymph node metastasis in the absence of other risk factors.

METHODS:

This nationwide, multicenter, prospective study conducted a post-hoc analysis of 141 patients with T1 colorectal cancer ≥20 mm where ESD of the lesion resulted in noncurative outcomes, characterized by poor differentiation, deep submucosal invasion (≥1000 µm), lymphovascular invasion, high-grade tumor budding, or positive vertical margins. Clinicopathologic features and patient prognoses focusing on lesion sites and additional surgery requirements were evaluated. Lymph node metastasis incidence in the low-risk T1 group, identified by deep submucosal invasion as the sole high-risk histological feature, was assessed.

RESULTS:

Lymph node metastasis occurred in 14% of patients undergoing additional surgery post-noncurative endoscopic submucosal dissection for T1 colorectal cancer. In the low-risk T1 group, in the absence of other risk factors, the frequency was 9.7%. The lymph node metastasis rates in patients with T1 colon and rectal cancers did not differ significantly (14% vs. 16%). Distant recurrence was observed in one patient (2.3%) in the ESD only group and in one (1.0%) in the additional surgery group, both of whom had had rectal cancer removed.

CONCLUSION:

The risk of lymph node metastasis or distant occurrence was not negligible, even in the low-risk T1 group. The findings suggest the need for considering additional surgery, particularly for rectal lesions (Clinical Trial Registration UMIN000010136).
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Dig Endosc Asunto de la revista: DIAGNOSTICO POR IMAGEM / GASTROENTEROLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Japón Pais de publicación: Australia
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Dig Endosc Asunto de la revista: DIAGNOSTICO POR IMAGEM / GASTROENTEROLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Japón Pais de publicación: Australia