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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(04): E282-E290
DOI: 10.1055/a-1736-6960
Original article

Impact of ≥ 0.1-mm free resection margins on local intramural residual cancer after local excision of T1 colorectal cancer

Kim M. Gijsbers
 1   Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
 2   Department of Gastroenterology & Hepatology, Deventer Hospital, Deventer, The Netherlands
,
Lisa van der Schee
 1   Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Tessa van Veen
 1   Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Annemarie M. van Berkel
 3   Department of Gastroenterology & Hepatology, Noordwest Hospital, Alkmaar,
The Netherlands
,
Femke Boersma
 4   Department of Gastroenterology & Hepatology, Gelre Hospital, Apeldoorn, The Netherlands
,
Carolien M. Bronkhorst
 5   Pathology-DNA, Jeroen Bosch Hospital, Den Bosch, The Netherlands
,
Paul D. Didden
 1   Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Krijn J.C. Haasnoot
 1   Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Anne M. Jonker
 6   Department of Pathology, Gelre Hospital, Apeldoorn, The Netherlands
,
Koen Kessels
 7   Department of Gastroenterology & Hepatology, St. Antonius Hospital, Nieuwegein,
The Netherlands
,
Nikki Knijn
 8   Pathology-DNA, Rijnstate Hospital, Arnhem, The Netherlands
,
Ineke van Lijnschoten
 9   Department of Pathology, PAMM, Eindhoven, The Netherlands
,
Clinton Mijnals
10   Department of Pathology, Amphia Hospital, Breda, The Netherlands
,
Anya N. Milne
11   Pathology-DNA, St. Antonius Hospital, Nieuwegein, The Netherlands
,
Freek C.P. Moll
12   Department of Pathology, Isala Clinics, Zwolle, The Netherlands
,
Ruud W.M. Schrauwen
13   Department of Gastroenterology & Hepatology, Bernhoven, Uden, The Netherlands
,
Ramon-Michel Schreuder
14   Department of Gastroenterology & Hepatology, Catharina Hospital, Eindhoven, The Netherlands
,
Tom J. Seerden
15   Department of Gastroenterology & Hepatology, Amphia Hospital, Breda, The Netherlands
,
Marcel B.W.M. Spanier
16   Department of Gastroenterology & Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
,
Jochim S. Terhaar Sive Droste
17   Department of Gastroenterology & Hepatology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
,
Emma Witteveen
18   Department of Pathology, Noordwest Hospital, Alkmaar, The Netherlands
,
Wouter H. de Vos tot Nederveen Cappel
19   Department of Gastroenterology & Hepatology, Isala Clinics, Zwolle, The Netherlands
,
Frank P. Vleggaar
 1   Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Miangela M. Laclé
20   Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Frank ter Borg‡
 2   Department of Gastroenterology & Hepatology, Deventer Hospital, Deventer, The Netherlands
,
Leon M.G. Moons‡
 1   Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Dutch T1 CRC Working Group › Author AffiliationsSupported by: Boks Scholten FoundationMaag Lever Darm Stichting MG/2015-040
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In addition to free deep margins, R0 resection should be required for T1 colorectal cancers to inform further surgical resectionEndosc Int Open 2022; 10(04): E291-E292
DOI: 10.1055/a-1776-7729

Abstract

Background and study aims A free resection margin (FRM) > 1 mm after local excision of a T1 colorectal cancer (CRC) is known to be associated with a low risk of local intramural residual cancer (LIRC). The risk is unclear, however, for FRMs between 0.1 to 1 mm. This study evaluated the risk of LIRC after local excision of T1 CRC with FRMs between 0.1 and 1 mm in the absence of lymphovascular invasion (LVI), poor differentiation and high-grade tumor budding (Bd2–3).

Patients and methods Data from all consecutive patients with local excision of T1 CRC between 2014 and 2017 were collected from 11 hospitals. Patients with a FRM ≥ 0.1 mm without LVI and poor differentiation were included. The main outcome was risk of LIRC (composite of residual cancer in the local excision scar in adjuvant resection specimens or local recurrence during follow-up). Tumor budding was also assessed for cases with a FRM between 0.1 and 1mm.

Results A total of 171 patients with a FRM between 0.1 and 1 mm and 351 patients with a FRM > 1 mm were included. LIRC occurred in five patients (2.9 %; 95 % confidence interval [CI] 1.0–6.7 %) and two patients (0.6 %; 95 % CI 0.1–2.1 %), respectively. Assessment of tumor budding showed Bd2–3 in 80 % of cases with LIRC and in 16 % of control cases. Accordingly, in patients with a FRM between 0.1 and 1 mm without Bd2–3, LIRC was detected in one patient (0.8%; 95 % CI 0.1–4.4 %).

Conclusions In this study, risks of LIRC were comparable for FRMs between 0.1 and 1 mm and > 1 mm in the absence of other histological risk factors.



Publication History

Received: 30 June 2021

Accepted after revision: 15 November 2021

Article published online:
14 April 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
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Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2022; 54(05): 527-527
DOI: 10.1055/a-1736-8035

 

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