Abstract
BackgroundEndoscopic treatment methods for early colorectal cancer (ECRC) mainly depend on the size and morphology. It is unclear whether different endoscopic resection methods could achieve curative resection for ECRC confined in the mucosa. The study was designed to compare the rate of positive vertical margin (VM) of ECRC with advanced adenomas (AAs) including adenoma > 1 cm, villous adenoma, high-grade intraepithelial neoplasia/dysplasia stratified by different endoscopic resection methods.MethodsRate of positive VM for 489 ECRCs including Intramucosal (pTis) and superficial submucosal invasion (pT1) carcinomas were compared with those of 753 AAs stratified by different endoscopic resection methods using Chi-squared test. Multivariate logistic model was performed to investigate the risk factors of positive VM for different endoscopic resection methods.ResultsThe pTis ECRC exhibited a similar rate of positive VM as that of AAs for en bloc hot snare polypectomy (HSP, 0% Vs. 0.85%, P = 0.617), endoscopic mucosal resection (EMR, 0.81% vs. 0.25%, P = 0.375) and endoscopic submucosal dissection (ESD, 1.82% Vs. 1.02%, P = 0.659). The pTis carcinoma was not found to be a risk factor for positive VM by en bloc EMR (P = 0.349) or ESD (P = 0.368). The en bloc resection achieved for pT1a carcinomas exhibited similar to positive VM achieved through ESD (2.06% Vs. 1.02%, P = 1.000) for AAs. Nonetheless, EMR resulted in higher risk of positive VM (5.41% Vs. 0.25%, P < 0.001) for pT1a carcinomas as compared to AAs. The pT1a invasion was identified as a risk factor for positive VM in polyps with en bloc EMR (odds ratio = 23.90, P = 0.005) but not ESD (OR = 2.96, P = 0.396).ConclusionCollectively, the pTis carcinoma was not found to be a risk factor for positive VM resected by en bloc HSP, EMR or ESD. Additionally, ESD may be preferred over EMR for pT1a carcinomas with lower rate of positive VM.
Highlights
Endoscopic treatment methods for early colorectal cancer (ECRC) mainly depend on the size and morphology
The exclusion criteria followed for the patients include: 1) Final pathology of lesion was diagnosed as squamous cell carcinoma or carcinoid tumor; 2) patients had familial adenomatous polyposis; 3) patients were diagnosed with inflammatory bowel disease; 4) patients had synchronous advanced CRCs
No significant difference was observed for lymphovascular invasion (LVI) status, positive horizontal margin (HM), positive vertical margin (VM) among different endoscopic resection methods
Summary
Endoscopic treatment methods for early colorectal cancer (ECRC) mainly depend on the size and morphology. It is unclear whether different endoscopic resection methods could achieve curative resection for ECRC confined in the mucosa. Colorectal cancer (ECRC) is defined as colorectal cancer (CRC) which has not invaded beyond submucosa regardless of lymph node metastasis (LNM). Owing to lower mortality and morbidity, endoscopic resection (ER), including polypectomy, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), are more attractive to patients with ECRC as compared to surgery [5]. According to the European [6], US [7] and Japanese [8] guidelines for the management of colorectal cancers, endoscopic modalities, including polypectomy, EMR and ESD, are all eligible for resection of polyps. In patients with vertical noncurative resection, additional surgery should be done [8, 9]
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