Nikas Samuolis1, Narimantas E Samalavicius2,3, Audrius Dulskas3,4,5, Rytis Markelis6, Raimundas Lunevicius7, Ugnius Mickys8, Ugne Ringeleviciute9. 1. Department of Surgery, Ukmerge Hospital, Ukmerge, Lithuania. 2. Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania. 3. Department of General and Abdominal Surgery and Oncology, Faculty of Medicine, Clinic of Internal, Family Medicine and Oncology, National Cancer Institute, Vilnius, Lithuania. 4. Department of General and Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania. 5. Faculty of Health Care, University of Applied Sciences, Vilnius, Lithuania. 6. Department of Surgery, Hospital of Oncology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania. 7. General Surgery Department, Aintree University Hospital NHS Foundation Trust, University of Liverpool, Liverpool, UK. 8. National Center of Pathology, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania. 9. Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Abstract
BACKGROUND: To evaluate indications for colectomy in T1 polyps and possible risk factors for lymph node metastasis. METHODS: Between 2004 and 2017, 40 patients underwent colectomy after endoscopic removal of malignant polyps with T1 carcinoma. Resection was done based on at least one of the unfavourable histopathological criteria. We collected and prospectively studied histopathologic features, short-term results and the benefit-risk balance. Complications were assessed by Clavien-Dindo classification. RESULTS: Twenty-five patients (62.5%) underwent laparoscopic bowel resection. Twenty-nine patients (63.0%) had more than two unfavourable criteria in the polyp that justified colorectal resection. Thirty-five patients (76%) had G2 (moderately differentiated) cancer, 11 (24%) had G1 (well-differentiated). Five patients (12.5%) had lymph node metastases and one (2.5%) had residual adenocarcinoma. All five patients with lymph node metastasis had G2 cancer. Nine patients (22.5%) had residual adenoma. Overall complications were identified in six (15.0%) patients. Oncologic benefit (or risk factors for lymph node metastasis) was significantly associated with polyp size ≥18 mm (P = 0.006), lymphovascular invasion (P = 0.05) and budding (P = 0.02). CONCLUSIONS: Female gender, lymphovascular invasion, desmoplastic reaction, criteria for surgery ≥2 and polyp size ≥18 mm were all in complex significant risk factors for lymph node metastasis in T1 colorectal cancer. Acting as a single factor, these variables had no effect to increased risk of metastasis.
BACKGROUND: To evaluate indications for colectomy in T1 polyps and possible risk factors for lymph node metastasis. METHODS: Between 2004 and 2017, 40 patients underwent colectomy after endoscopic removal of malignant polyps with T1 carcinoma. Resection was done based on at least one of the unfavourable histopathological criteria. We collected and prospectively studied histopathologic features, short-term results and the benefit-risk balance. Complications were assessed by Clavien-Dindo classification. RESULTS: Twenty-five patients (62.5%) underwent laparoscopic bowel resection. Twenty-nine patients (63.0%) had more than two unfavourable criteria in the polyp that justified colorectal resection. Thirty-five patients (76%) had G2 (moderately differentiated) cancer, 11 (24%) had G1 (well-differentiated). Five patients (12.5%) had lymph node metastases and one (2.5%) had residual adenocarcinoma. All five patients with lymph node metastasis had G2 cancer. Nine patients (22.5%) had residual adenoma. Overall complications were identified in six (15.0%) patients. Oncologic benefit (or risk factors for lymph node metastasis) was significantly associated with polyp size ≥18 mm (P = 0.006), lymphovascular invasion (P = 0.05) and budding (P = 0.02). CONCLUSIONS: Female gender, lymphovascular invasion, desmoplastic reaction, criteria for surgery ≥2 and polyp size ≥18 mm were all in complex significant risk factors for lymph node metastasis in T1 colorectal cancer. Acting as a single factor, these variables had no effect to increased risk of metastasis.