Effectiveness of radical surgery after incomplete endoscopic mucosal resection for early colorectal cancers: A clinical study investigating risk factors of residual cancer

Jae Hak Kim, JaeHee Cheon, Tae Il Kim, Seung Hyuk Baik, Namkyu Kim, Hoguen Kim, Won Ho Kim

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

The aim of this study was to determine the need for additional treatment following endoscopic mucosal resection for early colorectal cancer. Risk factors for residual carcinoma were investigated using specimens of curative surgical resection performed after endoscopic mucosal resection. A total of 44 patients who had received imperfect endoscopic mucosal resection initially for early colorectal cancers and, therefore, had undergone subsequent surgical resection were enrolled in this study. Of these, 39 (88.6%) were resected completely by endoscopic mucosal resection based on gross inspection, while the other five cases (11.4%) were incompletely resected. Histopathological examination of specimens of endoscopic mucosal resection revealed that microscopic lateral resection margin was positive in 11 cases (25.0%) and vertical resection margin was positive in 16 cases (36.4%). However, after curative surgery, residual cancer within colorectal tissue was found in only five cases (11.4%), while lymph node metastases were found in three cases (6.8%). Gross incomplete resection (P < 0.001) and microscopic vertical margin positivity (P = 0.031) were found to be risk factors of residual cancer within the colorectal tissue, whereas lymphovascular invasion was a risk factor for lymph node metastasis (P = 0.040). However, no residual cancer cells were found after supplementary surgery in the microscopic lateral resection margin-positive cases. In conclusion, grossly incomplete resection, microscopic vertical resection margin positivity, or the presence of lymphovascular invasion after endoscopic mucosal resection for early colorectal cancer indicate the need for further treatment with surgical resection and lymph node dissection. However, microscopic lateral margin positivity without gross remnant tumor and deep submucosal invasion might not indicate residual cancer. This needs to be further validated by a large scale, prospective study with long-term follow-up.

Original languageEnglish
Pages (from-to)2941-2946
Number of pages6
JournalDigestive Diseases and Sciences
Volume53
Issue number11
DOIs
Publication statusPublished - 2008 Nov 1

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Residual Neoplasm
Colorectal Neoplasms
Lymph Nodes
Neoplasm Metastasis
Lymph Node Excision
Endoscopic Mucosal Resection
Clinical Studies
Prospective Studies
Carcinoma
Margins of Excision
Therapeutics
Neoplasms

All Science Journal Classification (ASJC) codes

  • Gastroenterology
  • Physiology

Cite this

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title = "Effectiveness of radical surgery after incomplete endoscopic mucosal resection for early colorectal cancers: A clinical study investigating risk factors of residual cancer",
abstract = "The aim of this study was to determine the need for additional treatment following endoscopic mucosal resection for early colorectal cancer. Risk factors for residual carcinoma were investigated using specimens of curative surgical resection performed after endoscopic mucosal resection. A total of 44 patients who had received imperfect endoscopic mucosal resection initially for early colorectal cancers and, therefore, had undergone subsequent surgical resection were enrolled in this study. Of these, 39 (88.6{\%}) were resected completely by endoscopic mucosal resection based on gross inspection, while the other five cases (11.4{\%}) were incompletely resected. Histopathological examination of specimens of endoscopic mucosal resection revealed that microscopic lateral resection margin was positive in 11 cases (25.0{\%}) and vertical resection margin was positive in 16 cases (36.4{\%}). However, after curative surgery, residual cancer within colorectal tissue was found in only five cases (11.4{\%}), while lymph node metastases were found in three cases (6.8{\%}). Gross incomplete resection (P < 0.001) and microscopic vertical margin positivity (P = 0.031) were found to be risk factors of residual cancer within the colorectal tissue, whereas lymphovascular invasion was a risk factor for lymph node metastasis (P = 0.040). However, no residual cancer cells were found after supplementary surgery in the microscopic lateral resection margin-positive cases. In conclusion, grossly incomplete resection, microscopic vertical resection margin positivity, or the presence of lymphovascular invasion after endoscopic mucosal resection for early colorectal cancer indicate the need for further treatment with surgical resection and lymph node dissection. However, microscopic lateral margin positivity without gross remnant tumor and deep submucosal invasion might not indicate residual cancer. This needs to be further validated by a large scale, prospective study with long-term follow-up.",
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Effectiveness of radical surgery after incomplete endoscopic mucosal resection for early colorectal cancers : A clinical study investigating risk factors of residual cancer. / Kim, Jae Hak; Cheon, JaeHee; Kim, Tae Il; Baik, Seung Hyuk; Kim, Namkyu; Kim, Hoguen; Kim, Won Ho.

In: Digestive Diseases and Sciences, Vol. 53, No. 11, 01.11.2008, p. 2941-2946.

Research output: Contribution to journalArticle

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T1 - Effectiveness of radical surgery after incomplete endoscopic mucosal resection for early colorectal cancers

T2 - A clinical study investigating risk factors of residual cancer

AU - Kim, Jae Hak

AU - Cheon, JaeHee

AU - Kim, Tae Il

AU - Baik, Seung Hyuk

AU - Kim, Namkyu

AU - Kim, Hoguen

AU - Kim, Won Ho

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