Advertisement

Journal of Gastroenterology

, Volume 51, Issue 7, pp 702–710 | Cite as

Long-term outcomes after treatment for pedunculated-type T1 colorectal carcinoma: a multicenter retrospective cohort study

  • Naoki Asayama
  • Shiro OkaEmail author
  • Shinji Tanaka
  • Shinji Nagata
  • Akira Furudoi
  • Toshio Kuwai
  • Seiji Onogawa
  • Tadamasa Tamura
  • Hiroyuki Kanao
  • Yuko Hiraga
  • Hideharu Okanobu
  • Takayasu Kuwabara
  • Masaki Kunihiro
  • Shinichi Mukai
  • Eizo Goto
  • Fumio Shimamoto
  • Kazuaki Chayama
Original Article—Alimentary Tract

Abstract

Background

The risk for lymph node metastasis and the prognostic significance of pedunculated-type T1 colorectal carcinomas (CRCs) require further study. We aimed to assess the validity of the 2014 Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines based on long-term outcomes of pedunculated-type T1 CRCs.

Methods

In this multicenter retrospective cohort study, we examined 176 patients who underwent resection endoscopically or surgically at 14 institutions between January 1990 and December 2010. Patients meeting the JSCCR curative criteria were defined as “endoscopically curable (e-curable)” and those who did not were “non-e-curable”. We evaluated the prognosis of 116 patients (58 e-curable, 58 non-e-curable) who were observed for >5 years after treatment.

Results

Overall incidence of lymph node metastasis was 5 % (4/81; 95 % confidence interval 1.4–12 %: three cases of submucosal invasion depth ≥1000 μm [stalk invasion] and lymphatic invasion, one case of head invasion and budding grade 2/3). There was no local or metastatic recurrence in the e-curable patients, but six of them died of another cause (observation period, 80 months). There was no local recurrence in the non-e-curable patients; however, distant metastasis was observed in one patient. Death due to the primary disease was not observed in non-e-curable patients, but six of them died of another cause (observation period, 72 months).

Conclusions

Our data support the validity of the JSCCR curative criteria for pedunculated-type T1 CRCs. Endoscopic resection cannot be considered curative for pedunculated-type T1 CRC with head invasion alone.

Keywords

Pedunculated-type T1 colorectal carcinoma Lymph node metastasis Clinicopathological characteristics Outcomes 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Muto T, Oya M. Recent advances in diagnosis and treatment of colorectal T1 carcinoma. Dis Colon Rectum. 2003;46:S89–93.PubMedGoogle Scholar
  2. 2.
    Kyzer S, Begin LR, Gordon PH, et al. The care of patients with colorectal polyps that contain invasive adenocarcinoma: endoscopic polypectomy or colectomy? Cancer. 1992;70:2044–50.CrossRefPubMedGoogle Scholar
  3. 3.
    Asayama N, Oka S, Tanaka S, et al. Endoscopic submucosal dissection as total excisional biopsy for clinical T1 colorectal carcinoma. Digestion. 2015;27:216–22.Google Scholar
  4. 4.
    Tanaka S, Yokota T, Saito D, et al. Clinicopathologic features of early rectal carcinoma and indications for endoscopic treatment. Dis Colon Rectum. 1995;38:959–63.CrossRefPubMedGoogle Scholar
  5. 5.
    Tanaka S, Haruma K, Teixeira CR, et al. Endoscopic treatment of submucosal invasive colorectal carcinoma with special reference to risk factors for lymph node metastasis. J Gastroenterol. 1995;30:710–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Kobayashi H, Mochizuki H, Morita T, et al. Characteristics of recurrence after curative resection for T1 colorectal cancer: Japanese multicenter study. J Gastroenterol. 2011;46:203–11.CrossRefPubMedGoogle Scholar
  7. 7.
    Ueno H, Mochizuki H, Hashiguchi Y, et al. Risk factors for an adverse outcome in early invasive colorectal carcinoma. Gastroenterology. 2004;127:385–94.CrossRefPubMedGoogle Scholar
  8. 8.
    Nakadoi K, Tanaka S, Kanao H, et al. Management of T1 colorectal carcinoma with special reference to criteria for curative endoscopic resection. J Gastroenterol Hepatol. 2012;27:1057–62.CrossRefPubMedGoogle Scholar
  9. 9.
    Shatney CH, Lober PH, Gilbertson V, et al. Management of focally malignant pedunculated adenomatous colorectal polyps. Dis Colon Rectum. 1976;19:334–41.CrossRefPubMedGoogle Scholar
  10. 10.
    Wolff WI, Shinya H. Definitive treatment of “malignant” polyps of the colon. Ann Surg. 1975;182:516–25.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Kodaira S, Teramoto T, Ono S, et al. Lymph node metastases from carcinomas developing in pedunculated and semipedunculated colorectal adenomas. Aust N Z J Surg. 1981;51:429–33.CrossRefPubMedGoogle Scholar
  12. 12.
    Pines A, Bat L, Shemesh E, et al. Invasive colorectal adenomas: surgery versus colonoscopic polypectomy. J Surg Oncol. 1990;43:53–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Kikuchi R, Takano M, Takagi K, et al. Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum. 1995;38:1286–95.CrossRefPubMedGoogle Scholar
  14. 14.
    Kitajima K, Fujimori T, Fujii S, et al. Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J Gastroenterol. 2004;39:534–43.CrossRefPubMedGoogle Scholar
  15. 15.
    Matsuda T, Fukuzawa M, Uraoka T, et al. Risk of lymph node metastasis in patients with pedunculated type early invasive colorectal cancer: a retrospective multicenter study. Cancer Sci. 2011;102:1693–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Kobayashi H, Higuchi T, Uetake H, et al. Resection with en bloc removal of regional lymph node after endoscopic resection for T1 colorectal cancer. Ann Surg Oncol. 2012;19:4161–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Gordon MS, Cohen AM. Management of invasive carcinoma in pedunculated colorectal polyps. Oncology. 1989;3:99–104.PubMedGoogle Scholar
  18. 18.
    Colacchio TA, Forde KA, Scantlebury VP. Endoscopic polypectomy: inadequate treatment for invasive colorectal carcinoma. Ann Surg. 1981;194:704–7.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Watanabe T, Itabashi M, Shimada Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol. 2015;20:207–39.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Haggitt RC, Glotzbach RE, Soffer EE, et al. Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology. 1985;89:328–36.CrossRefPubMedGoogle Scholar
  21. 21.
    Yoshii S, Nojima M, Nosho K, et al. Factors associated with risk for colorectal cancer recurrence after endoscopic resection of T1 tumors. Clin Gastroenterol Hepatol. 2014;2:292–302.CrossRefGoogle Scholar
  22. 22.
    Ikematsu H, Yoda Y, Matsuda T, et al. Long-term outcomes after resection for submucosal invasive colorectal cancers. Gastroenterology. 2014;144:551–9.CrossRefGoogle Scholar
  23. 23.
    Yoda Y, Ikematsu H, Matsuda T, et al. A large-scale multicenter study of long-term outcomes after endoscopic resection for submucosal invasive colorectal cancer. Endoscopy. 2013;45:718–24.CrossRefPubMedGoogle Scholar
  24. 24.
    Choi DH, Sohn DK, Chang HJ, et al. Indications for subsequent surgery after endoscopic resection of submucosally invasive colorectal carcinomas: a prospective cohort study. Dis Colon Rectum. 2009;52:438–45.CrossRefPubMedGoogle Scholar
  25. 25.
    Di Gregorio C, Bonetti LR, de Gaetani C, et al. Clinical outcome of low- and high-risk malignant colorectal polyps: results of a population-based study and meta-analysis of the available literature. Intern Emerg Med. 2014;9:151–60.CrossRefPubMedGoogle Scholar
  26. 26.
    Tanaka S, Haruma K, Oh-e H, et al. Conditions of curability after endoscopic resection for colorectal carcinoma with submucosally massive invasion. Oncol Rep. 2000;7:783–8.PubMedGoogle Scholar
  27. 27.
    Okabe S, Shia J, Nash G, et al. Lymph node metastasis in T1 adenocarcinoma of the colon and rectum. J Gastrointest Surg. 2004;8:1032–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Tateishi Y, Nakanishi Y, Taniguchi H, et al. Pathological prognostic factors predicting lymph node metastasis in submucosal invasive (T1) colorectal carcinoma. Mod Pathol. 2010;23:1068–72.CrossRefPubMedGoogle Scholar
  29. 29.
    Wada H, Shiozawa M, Katayama K, et al. Systematic review and meta-analysis of histopathological predictive factors for lymph node metastasis in T1 colorectal cancer. J Gastroenterol. 2015;50:727–34.CrossRefPubMedGoogle Scholar
  30. 30.
    Nivatvongs S, Goldberg SM. Management of patients who have polyps containing invasive carcinoma removed via colonoscope. Dis Colon Rectum. 1978;21:8–11.CrossRefPubMedGoogle Scholar
  31. 31.
    Colacchio TA, Forde KA, Scantlebury VP. Endoscopic polypectomy: inadequate treatment for invasive colorectal carcinoma. Ann Surg. 1981;194:704–7.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Cooper HS. Surgical pathology of endoscopically removed malignant polyps of the colon and rectum. Am J Surg Pathol. 1983;7:613–23.CrossRefPubMedGoogle Scholar
  33. 33.
    Fenoglio CM, Kaye GI, Lane N. Distribution of human colonic lymphatics in normal, hyperplastic, and adenomatous tissue. Its relationship to metastasis from small carcinomas in pedunculated adenomas, with two case reports. Gastroenterology. 1973;64:51–66.PubMedGoogle Scholar
  34. 34.
    Oka S, Tanaka S, Kanao H, et al. Mid-term prognosis after endoscopic resection for submucosal colorectal carcinoma: summary of a multicenter questionnaire survey conducted by the colorectal endoscopic resection standardization implementation working group in Japanese Society for Cancer of the Colon and Rectum. Dig Endosc. 2011;23:190–4.CrossRefPubMedGoogle Scholar
  35. 35.
    Choi YS, Lee JB, Lee EJ, et al. Can endoscopic submucosal dissection technique be an alternative treatment option for a difficult giant (≥30 mm) pedunculated colorectal polyp? Dis Colon Rectum. 2013;56:660–6.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2015

Authors and Affiliations

  • Naoki Asayama
    • 1
  • Shiro Oka
    • 1
    Email author
  • Shinji Tanaka
    • 1
  • Shinji Nagata
    • 2
  • Akira Furudoi
    • 3
  • Toshio Kuwai
    • 4
  • Seiji Onogawa
    • 5
  • Tadamasa Tamura
    • 6
  • Hiroyuki Kanao
    • 7
  • Yuko Hiraga
    • 8
  • Hideharu Okanobu
    • 9
  • Takayasu Kuwabara
    • 10
  • Masaki Kunihiro
    • 11
  • Shinichi Mukai
    • 12
  • Eizo Goto
    • 13
  • Fumio Shimamoto
    • 14
  • Kazuaki Chayama
    • 15
  1. 1.Department of EndoscopyHiroshima University HospitalHiroshimaJapan
  2. 2.Department of GastroenterologyHiroshima City Asa Citizens HospitalHiroshimaJapan
  3. 3.Department of GastroenterologyJA Hiroshima General HospitalHiroshimaJapan
  4. 4.Department of GastroenterologyNational Hospital Organization Kure Medical Center and Chugoku Cancer CenterHiroshimaJapan
  5. 5.Department of GastroenterologyOnomichi General HospitalHiroshimaJapan
  6. 6.Department of Internal MedicineHiroshimakinen HospitalHiroshimaJapan
  7. 7.Department of GastroenterologyHiroshima Red Cross Hospital and Atomic-bomb Survivors HospitalHiroshimaJapan
  8. 8.Department of EndoscopyHiroshima Prefectural HospitalHiroshimaJapan
  9. 9.Department of GastroenterologyChugoku Rosai HospitalHiroshimaJapan
  10. 10.Department of GastroenterologyShobara Red Cross HospitalHiroshimaJapan
  11. 11.Department of Internal MedicineHiroshima City Hiroshima Citizens HospitalHiroshimaJapan
  12. 12.Department of GastroenterologyMiyoshi Central HospitalHiroshimaJapan
  13. 13.Department of GastroenterologyHigashihiroshima Medical CenterHiroshimaJapan
  14. 14.Department of Health Science, Faculty of Human Culture and SciencePrefectural University of HiroshimaHiroshimaJapan
  15. 15.Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan

Personalised recommendations