Surgery Today

, 38:675

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

  • Ichiro Nakada
  • Takanobu Tabuchi
  • Takeshi Nakachi
  • Jiro Shimazaki
  • Satoru Konishi
  • Motonobu Katano
  • Hideyuki Ubukata
  • Yoshihisa Goto
  • Yoshinori Watanabe
  • Takafumi Tabuchi
Review Article

DOI: 10.1007/s00595-007-3701-7

Cite this article as:
Nakada, I., Tabuchi, T., Nakachi, T. et al. Surg Today (2008) 38: 675. doi:10.1007/s00595-007-3701-7

Abstract

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.

Key words

Desmoplastic responsePoorly differentiated adenocarcinomaRecurrenceEndoscopic therapySubmucosal invasive cancerEarly colorectal cancer

Copyright information

© Springer 2008

Authors and Affiliations

  • Ichiro Nakada
    • 1
  • Takanobu Tabuchi
    • 1
  • Takeshi Nakachi
    • 1
  • Jiro Shimazaki
    • 1
  • Satoru Konishi
    • 1
  • Motonobu Katano
    • 1
  • Hideyuki Ubukata
    • 1
  • Yoshihisa Goto
    • 1
  • Yoshinori Watanabe
    • 1
  • Takafumi Tabuchi
    • 1
  1. 1.Department of SurgeryTokyo Medical University Kasumigaura HospitalAmi, Inashiki, IbarakiJapan