Endoscopy 2019; 51(04): S10-S11
DOI: 10.1055/s-0039-1681200
ESGE Days 2019 oral presentations
Friday, April 5, 2019 08:30 – 10:30: Colon ESD South Hall 2B
Georg Thieme Verlag KG Stuttgart · New York

LYMPHOVASCULAR INFILTRATION IS A HIGH RISK FACTOR FOR LYMPH NODE METASTASIS INDEPENDENT OF DEPTH OF INVASION IN T1 COLORECTAL CANCERS

H Thorlacius
1   Lund University, Surgery, Malmö, Sweden
,
CF Rönnow
1   Lund University, Surgery, Malmö, Sweden
,
V Andersson
1   Lund University, Surgery, Malmö, Sweden
,
E Toth
2   Lund University, Gastroenterology, Malmö, Sweden
,
I Syk
1   Lund University, Surgery, Malmö, Sweden
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

Depth of submucosal invasion is commonly used to predict risk for lymph node metastasis in T1 colorectal cancers although published data are conflicting on the risk of metastasis in relation to level of submucosal growth. The aim of this study was to identify risk factors for lymph node metastasis in T1 colorectal cancers.

Methods:

Data on all patients with T1 colorectal cancer undergoing surgical resection between 2009 – 2017 were collected from the Swedish Colorectal Cancer Registry. Potential risk factors for lymph node metastasis, including age, gender, tumour location, submucosal invasion (Sm1 – 3), grade of differentiation, lymphovascular invasion, perineural invasion, tumour deposits and mucinous subtype were recorded. Patients lacking one of these factors were not included.

Results:

991 patients (51% male) were included with median age of 72 years. 110 patients (11%) had lymph node metastasis in the surgical specimens. The overall incidence of lymph node metastasis was 8% (26/314) in Sm1, 12% (28/231) in Sm2 and 13% (56/446) in Sm3. In the absence of lymphovascular infiltration, the rate of lymph node metastasis was 6% in Sm1, 9% in Sm2 and 13% in Sm3. Notably, the incidence of lymph node metastasis markedly increased to 40% (37/92) in cases with lymphovascular infiltration regardless of Sm classification. Presence of tumor deposits (14 cases) and perineural invasion (15 cases) also increased the rate of metastasis but the numbers of these cases were too few for solid conclusions. Grade of differentiation and mucinous subtype had only a minor impact on the incidence of lymph node metastasis (16%).

Conclusions:

Thisis the largest study in the literature examining risk factors for lymph node metastasis in T1 colorectal cancers. Our results show that depth of submucosal invasion has limited influence and that lymphovascular infiltration is the most important risk predictor for lymph node metastasis in T1 colorectal cancers.