Endosc Int Open 2015; 03(03): E252-E257
DOI: 10.1055/s-0034-1391853
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Relationship between indeterminate or positive lateral margin and local recurrence after endoscopic resection of colorectal polyps

Makomo Makazu
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Taku Sakamoto
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Eriko So
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Yosuke Otake
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Takeshi Nakajima
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Takahisa Matsuda
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Ryoji Kushima
2   Pathology Division, National Cancer Center Hospital, Tokyo, Japan
,
Yutaka Saito
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

submitted 09 June 2014

accepted after revision 13 February 2015

Publication Date:
05 May 2015 (online)

Background and study aims: Although endoscopic resection is widely used for the treatment of superficial colorectal neoplasms, the rate of local recurrence of lesions with a positive or indeterminate lateral margin on histologic evaluation is unclear. We aimed to demonstrate the relationship between lateral margin status and local recurrence after the endoscopic resection of intramucosal colorectal neoplasms.

Patients and methods: We retrospectively collected the clinical and pathologic data for 844 endoscopically resected colorectal intramucosal neoplasms with a size of 10 mm or larger. We investigated the relationship between the local recurrence rate and the lateral margin status (categorized as LM0 [negative], LM1 [positive], or LMX [indeterminate]).

Results: In total, 389 lesions were evaluated as LM0 and showed no local recurrence. Of the 455 lesions evaluated as LMX or LM1, 30 showed local recurrence within a median period of 6.3 months (range, 1.7 – 48.1) from the initial endoscopic resection. The local recurrence rate of the en bloc-LMX group (2.2 %) was significantly lower than that of the piecemeal-LMX group (15.2 %). Of the 30 cases of recurrence, 28 were successfully treated with a second endoscopic resection. Of the two lesions that showed further recurrence, one was treated with a third endoscopic resection, whereas the other – which was a piecemeal-LMX lesion – was eventually diagnosed as invasive cancer and treated with surgery.

Conclusions: The local recurrence rate was lower in the en bloc-LMX group than in the piecemeal-LMX group. Thus, we believe that en bloc-LMX lesions that are completely and confidently resected endoscopically can be treated as en bloc-LM0 lesions.

 
  • References

  • 1 Deyhle P, Seuberth K, Jenny S et al. Endoscopic polypectomy in the proximal colon. Endoscopy 1971; 3: 103-115
  • 2 Deyhle P, Largiader F, Fumagalli S. A method for endoscopic electroresection of sessile colonic polyps. Endoscopy 1973; 5: 38-40
  • 3 Kudo S. Endoscopic mucosal resection of flat and depressed type of early colorectal cancer. Endoscopy 1993; 25: 455-461
  • 4 Ahmad NA, Kochman ML, Long WB et al. Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of 101 cases. Gastrointest Endosc 2002; 55: 390-396
  • 5 Moss A, Bourke MJ, Williams SJ et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 2011; 140: 1909-1918
  • 6 Ohkuwa M, Hosokawa N, Boku N et al. New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife. Endoscopy 2001; 33: 221-226
  • 7 Ono H, Kondo H, Gotoda T et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48: 225-229
  • 8 Gotoda T, Kondo H, Ono H et al. A new endoscopic resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases. Gastrointest Endosc 1999; 50: 560-563
  • 9 Tamegai Y, Saito Y, Masaki N et al. Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy 2007; 39: 418-422
  • 10 Saito Y, Uraoka T, Yamaguchi Y et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 2010; 72: 1217-1225
  • 11 Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal carcinoma. 2nd. edn. Tokyo, Japan: Lanehara; 2009
  • 12 Watanabe T, Itabashi M, Shimada Y et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol 2012; 17: 1-29
  • 13 Pohl E, Srivastava A, Bensen SP et al. Incomplete polyp resection during colonoscopy – results of the complete adenoma resection (CARE) study. Gastroenterology 2013; 144: 74-80
  • 14 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. Gastrointest Endosc 2003; 58: S3-S43
  • 15 Kudo S, Hirota S, Nakajima T et al. Colorectal tumours and pit pattern. J Clin Pathol 1994; 47: 880-885
  • 16 Fujii T, Hasegawa RT, Saitoh Y et al. Chromoscopy during colonoscopy. Endoscopy 2001; 33: 1036-1041
  • 17 Matsuda T, Fujii T, Saito Y et al. Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms. Am J Gastroenterol 2008; 103: 2700-2706
  • 18 Sano Y, Horimatsu T, Fu KI et al. Magnifying observation of microvascular architecture of colorectal lesions using a narrow band imaging system. Dig Endosc 2006; 18: 44-S51
  • 19 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: 966-973
  • 20 Iishi H, Tatsuta M, Iseki K. Endoscopic mucosal resection with submucosal saline injection of large sessile colorectal polyps. Gastrointest Endosc 2000; 51: 697-700
  • 21 Higaki S, Hashimoto S, Harada K et al. Long-term follow-up of large flat colorectal tumors resected endoscopically. Endoscopy 2003; 35: 845-849
  • 22 Hotta K, Fujii T, Saito Y et al. Local recurrence after endoscopic resection of colorectal tumors. Int J Colorectal Dis 2009; 24: 225-230
  • 23 Saito Y, Fukuzawa M, Matsuda T et al. Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 2010; 24: 343-352
  • 24 Kim JH, Cheon JH, Kim TI et al. Effectiveness of radical surgery after incomplete endoscopic mucosal resection for early colorectal cancers: a clinical study investigating risk factors of residual cancer. Dig Dis Sci 2008; 53: 2941-2946
  • 25 Kim KM, Eo SJ, Shim SG et al. Risk factors for residual cancer and lymph node metastasis after noncurative endoscopic resection of early colorectal cancer. Dis Colon Rectum 2013; 56: 35-42
  • 26 Lauwers GY, Ban S, Mino M et al. Endoscopic mucosal resection for gastric epithelial neoplasms: a study of 39 cases with emphasis on the evaluation of specimens and recommendations for optimal pathologic analysis. Mod Pathol 2004; 17: 2-8
  • 27 Sakamoto T, Matsuda T, Otake Y et al. Predictive factors of local recurrence after endoscopic piecemeal mucosal resection. J Gastroenterol 2012; 47: 635-640
  • 28 Winawer SJ, Zauber AG, Fletcher RH et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology 2006; 230: 1872-1885
  • 29 Hurlstone DP, Cross SS, Brown S et al. A prospective evaluation of high-magnification chromoscopic colonoscopy in predicting completeness of EMR. Gastrointest Endosc 2004; 59: 642-650