Naoki Asayama1, Shiro Oka2, Shinji Tanaka1, Shinji Nagata3, Akira Furudoi4, Toshio Kuwai5, Seiji Onogawa6, Tadamasa Tamura7, Hiroyuki Kanao8, Yuko Hiraga9, Hideharu Okanobu10, Takayasu Kuwabara11, Masaki Kunihiro12, Shinichi Mukai13, Eizo Goto14, Fumio Shimamoto15, Kazuaki Chayama16. 1. Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan. 2. Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan. oka4683@hiroshima-u.ac.jp. 3. Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan. 4. Department of Gastroenterology, JA Hiroshima General Hospital, Hiroshima, Japan. 5. Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan. 6. Department of Gastroenterology, Onomichi General Hospital, Hiroshima, Japan. 7. Department of Internal Medicine, Hiroshimakinen Hospital, Hiroshima, Japan. 8. Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan. 9. Department of Endoscopy, Hiroshima Prefectural Hospital, Hiroshima, Japan. 10. Department of Gastroenterology, Chugoku Rosai Hospital, Hiroshima, Japan. 11. Department of Gastroenterology, Shobara Red Cross Hospital, Hiroshima, Japan. 12. Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan. 13. Department of Gastroenterology, Miyoshi Central Hospital, Hiroshima, Japan. 14. Department of Gastroenterology, Higashihiroshima Medical Center, Hiroshima, Japan. 15. Department of Health Science, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan. 16. Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
Abstract
BACKGROUND: The risk for lymph node metastasis and the prognostic significance of pedunculated-type T1 colorectal carcinomas (CRCs) require further study. We aimed to assess the validity of the 2014 Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines based on long-term outcomes of pedunculated-type T1 CRCs. METHODS: In this multicenter retrospective cohort study, we examined 176 patients who underwent resection endoscopically or surgically at 14 institutions between January 1990 and December 2010. Patients meeting the JSCCR curative criteria were defined as "endoscopically curable (e-curable)" and those who did not were "non-e-curable". We evaluated the prognosis of 116 patients (58 e-curable, 58 non-e-curable) who were observed for >5 years after treatment. RESULTS: Overall incidence of lymph node metastasis was 5 % (4/81; 95 % confidence interval 1.4-12 %: three cases of submucosal invasion depth ≥1000 μm [stalk invasion] and lymphatic invasion, one case of head invasion and budding grade 2/3). There was no local or metastatic recurrence in the e-curable patients, but six of them died of another cause (observation period, 80 months). There was no local recurrence in the non-e-curable patients; however, distant metastasis was observed in one patient. Death due to the primary disease was not observed in non-e-curable patients, but six of them died of another cause (observation period, 72 months). CONCLUSIONS: Our data support the validity of the JSCCR curative criteria for pedunculated-type T1 CRCs. Endoscopic resection cannot be considered curative for pedunculated-type T1 CRC with head invasion alone.
BACKGROUND: The risk for lymph node metastasis and the prognostic significance of pedunculated-type T1 colorectal carcinomas (CRCs) require further study. We aimed to assess the validity of the 2014 Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines based on long-term outcomes of pedunculated-type T1 CRCs. METHODS: In this multicenter retrospective cohort study, we examined 176 patients who underwent resection endoscopically or surgically at 14 institutions between January 1990 and December 2010. Patients meeting the JSCCR curative criteria were defined as "endoscopically curable (e-curable)" and those who did not were "non-e-curable". We evaluated the prognosis of 116 patients (58 e-curable, 58 non-e-curable) who were observed for >5 years after treatment. RESULTS: Overall incidence of lymph node metastasis was 5 % (4/81; 95 % confidence interval 1.4-12 %: three cases of submucosal invasion depth ≥1000 μm [stalk invasion] and lymphatic invasion, one case of head invasion and budding grade 2/3). There was no local or metastatic recurrence in the e-curable patients, but six of them died of another cause (observation period, 80 months). There was no local recurrence in the non-e-curable patients; however, distant metastasis was observed in one patient. Death due to the primary disease was not observed in non-e-curable patients, but six of them died of another cause (observation period, 72 months). CONCLUSIONS: Our data support the validity of the JSCCR curative criteria for pedunculated-type T1 CRCs. Endoscopic resection cannot be considered curative for pedunculated-type T1 CRC with head invasion alone.
Authors: S Tanaka; K Haruma; C R Teixeira; S Tatsuta; N Ohtsu; Y Hiraga; M Yoshihara; K Sumii; G Kajiyama; F Shimamoto Journal: J Gastroenterol Date: 1995-12 Impact factor: 7.527