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Clinical outcomes of submucosal colorectal cancer diagnosed after endoscopic resection: a focus on the need for surgery

Intestinal Research 2020년 18권 1호 p.96 ~ 106
최윤식 ( Choi Yun-Sik ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology

김완수 ( Kim Wan-Soo ) - Gyeongsang National University Changwon Hospital Department of Internal Medicine
황성욱 ( Hwang Sung-Wook ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
박상형 ( Park Sang-Hyoung ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
양동훈 ( Yang Dong-Hoon ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
예병덕 ( Ye Byong-Duk ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
명승재 ( Myung Seung-Jae ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
양석균 ( Yang Suk-Kyun ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
변정식 ( Byeon Jeong-Sik ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology

Abstract


Background/Aims: We aimed to investigate the proportion of and risk factors for residual cancer and/or lymph node metastasis after surgery was performed because of high-risk pathological features in endoscopic resection specimen of suspected superficial submucosal colorectal cancer (SSMC).

Methods: We reviewed medical records of 497 patients (58.8 ± 9.8 years, 331 males) undergoing endoscopic resection of suspected SSMC. High-risk pathological features included: deep submucosal cancer invasion ≥ 1,000 μm; positive lymphovascular and/or perineural invasion; poorly differentiated adenocarcinoma; and positive resection margin. We investigated the occurrence of additional surgery and residual cancer and/or lymph node involvement in the surgical specimen.

Results: En bloc resection was performed in 447 patients (89.9%). High-risk pathological features were detected in 372 patients (74.8%). Additional surgery was performed in 336 of 372 patients with high-risk pathological features. Of these, 47 surgical specimens (14.0%) showed residual cancer and/or lymph node metastasis. Piecemeal resection was more common in those with residual cancer and/or lymph node involvement than those without (9/47 [19.1%] vs. 24/289 [8.3%], P= 0.032). Positive resection margin was also significantly associated with positive residual cancer and/or lymph node involvement. As the number of high-risk pathological features increased, the risk of regional lymph node metastasis increased proportionally (P= 0.002).

Conclusions: High-risk pathological features were frequently detected after endoscopic resection of suspected SSMC while residual cancer and/or lymph node metastasis were not commonly present in the additional surgical specimen. Further optimized strategy for proper endoscopic management of suspected SSMC is necessary.

키워드

Submucosal colorectal cancer; Endoscopic resection; Surgery
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