Skip to main content
Erschienen in: Annals of Surgical Oncology 13/2012

01.12.2012 | Colorectal Cancer

Resection with En Bloc Removal of Regional Lymph Node after Endoscopic Resection for T1 Colorectal Cancer

verfasst von: Hirotoshi Kobayashi, MD, Tetsuro Higuchi, MD, Hiroyuki Uetake, MD, Satoru Iida, MD, Toshiaki Ishikawa, MD, Megumi Ishiguro, MD, Kenichi Sugihara, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 13/2012

Einloggen, um Zugang zu erhalten

Abstract

Background

Various guidelines suggest indications for performing additional colectomy with en bloc removal of regional lymph nodes after endoscopic resection for T1 colon cancer. The aim of this study was to evaluate the pathologic outcomes of patients with surgical treatment after endoscopic resection for T1 colorectal cancer.

Methods

We used data from 275 patients who had undergone curative resection for T1 colorectal cancer at a single institution between 1991 and 2009. We evaluated the rationale for additional surgical treatment after endoscopic resection performed on 68 of the 275 patients and the association between various clinicopathologic features and lymph node metastasis.

Results

The 5-year overall survival rate was 96.3 %. Reasons for additional surgical treatment included an endoscopic specimen with a pathologically positive margin (n = 20), lymphovascular invasion (n = 25), and submucosal invasion depth of ≥1,000 μm (n = 23). When endoscopists failed to find macroscopic cancer residue during endoscopic resection, no pathologically residual cancer was found in the resected specimens. Histologic grade was an independent risk factor for lymph node metastasis (p = 0.028). In the absence of lymphovascular invasion, patients with well-differentiated T1 colorectal cancer did not have nodal involvement.

Conclusions

Although the outcomes of patients with additional surgical treatment after endoscopic resection for T1 colorectal cancer were satisfactory, excessive and unnecessary treatments may have been performed. Additional surgical treatment after endoscopic resection for T1 colorectal cancer might be unnecessary for patients with well-differentiated adenocarcinoma and no lymphovascular invasion.
Literatur
1.
Zurück zum Zitat Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009;59:225–49.PubMedCrossRef Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009;59:225–49.PubMedCrossRef
2.
Zurück zum Zitat Kotake K, Honjo S, Sugihara K, et al. Changes in colorectal cancer during a 20-year period: an extended report from the multi-institutional registry of large bowel cancer, Japan. Dis Colon Rectum. 2003;46:S32–43.PubMed Kotake K, Honjo S, Sugihara K, et al. Changes in colorectal cancer during a 20-year period: an extended report from the multi-institutional registry of large bowel cancer, Japan. Dis Colon Rectum. 2003;46:S32–43.PubMed
3.
Zurück zum Zitat Fujishiro M, Yahagi N, Nakamura M, et al. Successful outcomes of a novel endoscopic treatment for GI tumors: endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar. Gastrointest Endosc. 2006;63:243–9.PubMedCrossRef Fujishiro M, Yahagi N, Nakamura M, et al. Successful outcomes of a novel endoscopic treatment for GI tumors: endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar. Gastrointest Endosc. 2006;63:243–9.PubMedCrossRef
4.
Zurück zum Zitat Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy. 1993;25:455–61.PubMedCrossRef Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy. 1993;25:455–61.PubMedCrossRef
5.
Zurück zum Zitat Saito Y, Uraoka T, Matsuda T, et al. Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc. 2007;66:966–73.PubMedCrossRef Saito Y, Uraoka T, Matsuda T, et al. Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc. 2007;66:966–73.PubMedCrossRef
6.
Zurück zum Zitat Tanaka S, Oka S, Kaneko I, et al. Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc. 2007;66:100–7.PubMedCrossRef Tanaka S, Oka S, Kaneko I, et al. Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc. 2007;66:100–7.PubMedCrossRef
7.
Zurück zum Zitat Kobayashi H, Mochizuki H, Kato T, et al. Is total mesorectal excision always necessary for T1–T2 lower rectal cancer? Ann Surg Oncol. 2010;17:973–80.PubMedCrossRef Kobayashi H, Mochizuki H, Kato T, et al. Is total mesorectal excision always necessary for T1–T2 lower rectal cancer? Ann Surg Oncol. 2010;17:973–80.PubMedCrossRef
8.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
9.
Zurück zum Zitat Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum. 2002;45:200–6.PubMedCrossRef Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum. 2002;45:200–6.PubMedCrossRef
10.
Zurück zum Zitat Nivatvongs S, Rojanasakul A, Reiman HM, et al. The risk of lymph node metastasis in colorectal polyps with invasive adenocarcinoma. Dis Colon Rectum. 1991;34:323–8.PubMedCrossRef Nivatvongs S, Rojanasakul A, Reiman HM, et al. The risk of lymph node metastasis in colorectal polyps with invasive adenocarcinoma. Dis Colon Rectum. 1991;34:323–8.PubMedCrossRef
11.
Zurück zum Zitat Japanese Society for Cancer of the Colon and Rectum. JSCCR guidelines 2010 for the treatment of colorectal cancer. Tokyo: Kanehara, 2010 (in Japanese). Japanese Society for Cancer of the Colon and Rectum. JSCCR guidelines 2010 for the treatment of colorectal cancer. Tokyo: Kanehara, 2010 (in Japanese).
12.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
13.
Zurück zum Zitat Haggitt RC, Glotzbach RE, Soffer EE, Wruble LD. Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology. 1985;89:328–36.PubMed Haggitt RC, Glotzbach RE, Soffer EE, Wruble LD. Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology. 1985;89:328–36.PubMed
14.
Zurück zum Zitat Labianca R, Nordlinger B, Beretta GD, Brouquet A, Cervantes A. Primary colon cancer: ESMO clinical practice guidelines for diagnosis, adjuvant treatment and follow-up. Ann Oncol. 2010;21(Suppl. 5):v70–7.PubMedCrossRef Labianca R, Nordlinger B, Beretta GD, Brouquet A, Cervantes A. Primary colon cancer: ESMO clinical practice guidelines for diagnosis, adjuvant treatment and follow-up. Ann Oncol. 2010;21(Suppl. 5):v70–7.PubMedCrossRef
16.
Zurück zum Zitat Cooper HS, Deppisch LM, Gourley WK, et al. Endoscopically removed malignant colorectal polyps: clinicopathologic correlations. Gastroenterology. 1995;108:1657–65.PubMedCrossRef Cooper HS, Deppisch LM, Gourley WK, et al. Endoscopically removed malignant colorectal polyps: clinicopathologic correlations. Gastroenterology. 1995;108:1657–65.PubMedCrossRef
17.
Zurück zum Zitat Kobayashi H, Ueno H, Hashiguchi Y, Mochizuki H. Distribution of lymph node metastasis is a prognostic index in patients with stage III colon cancer. Surgery. 2006;139:516–22.PubMedCrossRef Kobayashi H, Ueno H, Hashiguchi Y, Mochizuki H. Distribution of lymph node metastasis is a prognostic index in patients with stage III colon cancer. Surgery. 2006;139:516–22.PubMedCrossRef
18.
Zurück zum Zitat Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal carcinoma. Tokyo: Kanehara, 2009. Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal carcinoma. Tokyo: Kanehara, 2009.
19.
Zurück zum Zitat Berger AC, Sigurdson ER, LeVoyer T, et al. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol. 2005;23:8706–12.PubMedCrossRef Berger AC, Sigurdson ER, LeVoyer T, et al. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol. 2005;23:8706–12.PubMedCrossRef
20.
Zurück zum Zitat Kobayashi H, Enomoto M, Higuchi T, et al. Clinical significance of lymph node ratio and location of nodal involvement in patients with right colon cancer. Dig Surg. 2011;28:190–7.PubMedCrossRef Kobayashi H, Enomoto M, Higuchi T, et al. Clinical significance of lymph node ratio and location of nodal involvement in patients with right colon cancer. Dig Surg. 2011;28:190–7.PubMedCrossRef
21.
Zurück zum Zitat Kobayashi H, Mochizuki H, Kato T, et al. Lymph node ratio is a powerful prognostic index in patients with stage III distal rectal cancer: a Japanese multicenter study. Int J Colorectal Dis. 2011;26:891–6.PubMedCrossRef Kobayashi H, Mochizuki H, Kato T, et al. Lymph node ratio is a powerful prognostic index in patients with stage III distal rectal cancer: a Japanese multicenter study. Int J Colorectal Dis. 2011;26:891–6.PubMedCrossRef
22.
Zurück zum Zitat Peschaud F, Benoist S, Julie C, et al. The ratio of metastatic to examined lymph nodes is a powerful independent prognostic factor in rectal cancer. Ann Surg. 2008;248:1067–73.PubMedCrossRef Peschaud F, Benoist S, Julie C, et al. The ratio of metastatic to examined lymph nodes is a powerful independent prognostic factor in rectal cancer. Ann Surg. 2008;248:1067–73.PubMedCrossRef
23.
Zurück zum Zitat Rosenberg R, Friederichs J, Schuster T, et al. Prognosis of patients with colorectal cancer is associated with lymph node ratio: a single-center analysis of 3,026 patients over a 25-year time period. Ann Surg. 2008;248:968–78.PubMedCrossRef Rosenberg R, Friederichs J, Schuster T, et al. Prognosis of patients with colorectal cancer is associated with lymph node ratio: a single-center analysis of 3,026 patients over a 25-year time period. Ann Surg. 2008;248:968–78.PubMedCrossRef
24.
Zurück zum Zitat West NP, Kobayashi H, Takahashi K, et al. Understanding optimal colonic cancer surgery: comparison of Japanese d3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol. 2012;30:1763–9.PubMedCrossRef West NP, Kobayashi H, Takahashi K, et al. Understanding optimal colonic cancer surgery: comparison of Japanese d3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol. 2012;30:1763–9.PubMedCrossRef
Metadaten
Titel
Resection with En Bloc Removal of Regional Lymph Node after Endoscopic Resection for T1 Colorectal Cancer
verfasst von
Hirotoshi Kobayashi, MD
Tetsuro Higuchi, MD
Hiroyuki Uetake, MD
Satoru Iida, MD
Toshiaki Ishikawa, MD
Megumi Ishiguro, MD
Kenichi Sugihara, MD
Publikationsdatum
01.12.2012
Verlag
Springer-Verlag
Erschienen in
Annals of Surgical Oncology / Ausgabe 13/2012
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2471-7

Weitere Artikel der Ausgabe 13/2012

Annals of Surgical Oncology 13/2012 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.