Histological factors contributing to a high risk of recurrence of submucosal invasive cancer (pT1) of the colon and rectum after endoscopic therapy

Department of Surgery, Tokyo Medical University Kasumigaura Hospital, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan.
Surgery Today (Impact Factor: 1.53). 08/2008; 38(8):675-8. DOI: 10.1007/s00595-007-3701-7
Source: PubMed


We analyzed the histological high-risk factors for recurrence of submucosal invasive carcinomas (pT1) of the colon and rectum after endoscopic therapy, examining pT1 cancers treated primarily by endoscopic resection within a 23-year period. We compared recurrent and nonrecurrent cancers, evaluating the following "highrisk factors" of the primary lesion: massive invasion, a surgical margin<2 mm but negativity for cancer in the cut end, poorly differentiated adenocarcinoma (PD) (G3), undifferentiated carcinoma (G4), and/or positive angiolymphatic invasion. The following histological factors were defined as predictive of a low risk: minimum invasion, a surgical margin>2 mm, well or moderately differentiated adenocarcinoma (G1, G2), and no evidence of angiolymphatic invasion. We analyzed the records of 37 patients with pT1 cancers, including 15 with high-risk factors who underwent subsequent resection. Local recurrence with or without liver metastases developed in 4 of these 15 patients. The histological type was PD in three (75%) of the four recurrent lesions. All four (100%) lesions showed a desmoplastic response (DR). Only 1 (9%) of the 11 patients without recurrence after subsequent surgery had a lesion with a small component of PD, and only three (27%) lesions showed a mild DR. We concluded that endoscopic therapy is inadequate for pT1 cancers with a histological PD component, and/or a DR in the cancer stroma.

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    • "In the second patient, both locoregional and systemic recurrences were observed 3.9 years after surgical resection, although lymph node metastasis was not identified in the primary tumor. Since a study of endoscopically-resected SICC demonstrated that recurrent primary cancers were significantly associated with poorly differentiated histology,18 we believed that other factors may have contributed to disease recurrence in these 2 patients. A thorough retrospective histologic review revealed frequent tumor budding from both tumors. "
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    ABSTRACT: Complete resection of submucosal invasive colorectal cancer (SICC) showing favorable histology is regarded as curative. We report on two cases of SICC showing recurrence within 5 years despite complete resection. The first patient was a 68-year-old woman with well differentiated rectal adenocarcinoma invading the superficial submucosa, which recurred after 4.7 years. The second patient was a 53-year-old man with pT1N0 moderately differentiated colonic adenocarcinoma. He developed widespread tumor recurrence after 3.9 years. Retrospective pathologic review of the original tumors showed multiple foci of tumor budding at the invasive front. Immunohistochemical staining for D2-40 of deeper levels of the paraffin blocks showed rare foci of small lymphatic invasion. Tumor budding at the invasive front may be an important indicator for SICC aggressiveness or may reflect early lymphatic invasion. More aggressive pathologic examination and follow-up is required for patients with SICC showing tumor budding, even in the absence of unfavorable histologic findings.
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    Surgery Today 02/2009; 39(7):619-23. DOI:10.1007/s00595-008-3884-6 · 1.53 Impact Factor
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    Surgery Today 03/2010; 40(3):245-250. DOI:10.1007/s00595-009-4028-3 · 1.53 Impact Factor
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