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Histological Risk Factors for Lymph Node Metastasis in pT1 colorectal cancer:Does Submucosal Invasion Depth Really Matter?

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Current Medical Science 2024年第5期44卷 1026-1035页

作者： Bing YUE Mei JIA Rui XU Guang-yong CHEN Mu-lan JIN Department of Pathology Beijing Friendship HospitalCapital Medical UniversityBeijing100050China Department of Pathology Beijing Chaoyang HospitalCapital Medical UniversityBeijing100015China

Objective After endoscopic resection of colorectal cancer with submucosal invasion(pT1 CRC),additional surgical treatment is recommended if deep submucosal invasion(DSI)is *** study aimed to further elucidate the risk factors for lymph node metastasis(LNM)in patients with pT1 CRC,especially the effect of DSI on *** Patients with pT1 CRC who underwent lymph node dissection were *** Chi-square test and multivariate logistic regression were used to analyze the relationship between clinicopathological characteristics and *** submucosal invasion depth(SID)was measured via 4 methods and analyzed with 3 cut-off *** Twenty-eight of the 239 patients presented with LNM(11.7%),and the independent risk factors for LNM included high histological grade(P=0.003),lymphovascular invasion(LVI)(P=0.004),intermediate to high budding(Bd 2/3)(P=0.008),and cancer gland rupture(CGR)(P=0.008).Moreover,the SID,width of submucosal invasion(WSI),and area of submucosal invasion(ASI)were not significantly *** one,two,three or more risk factors were identified,the LNM rates were 1.1%(1/95),12.5%(7/56),and 48.8%(20/41),*** Indicators such as the SID,WSI,and ASI are not risk factors for LNM and are subjective in their measurement,which renders them relatively inconvenient to apply in clinical *** contrast,histological grade,LVI,tumor budding and CGR are relatively straightforward to identify and have been demonstrated to be statistically *** would be prudent to focus on these histological factors rather than subjective measurements.

关键词： lymph node metastasis early colorectal cancer lymph node dissection submucosal invasion depth tumor budding cancer gland rupture

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Decreased levels of plasma adiponectin associated with increased risk of colorectal cancer

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World Journal of Gastroenterology 2010年第10期16卷 1252-1257页

作者： Sayaka Otake Hiroaki Takeda Shoichiro Fujishima Tadahisa Fukui Tomohiko Orii Takeshi Sato Yu Sasaki Shoichi Nishise Sumio Kawata Department of Gastroenterology Yamagata University Faculty of Medicine Division of Endoscopy Yamagata University Hospital

AIM:To investigate the association between adiponectin levels and risk of colorectal adenoma and cancer (early and advanced).METHODS: A cross-sectional study in a cohort of hospital-based patients was conducted between January 2004 and March 2006 at Yamagata University Hospital. Male subjects, who had colorectal tumors detected by endoscopic examination, were enrolled according to inclusion and exclusion criteria. Based on the T factor of the TNM system, intraepithelial carcinoma and submucosally invasive carcinoma were def ined as early cancer, and invasion into the muscularis propria or deeper was defined as advanced cancer. The plasma levels of glucose, insulin, total cholesterol, triglyceride, high sensitivity C-reactive protein, insulin like growth factor (IGF)-1, IGF binding protein-3, adiponectin, leptin, and resistin were measured. Each factor level was designated low or high, and the risk of adenoma or cancer was estimated by univariate and multivariate logistic regression ***: We enrolled 124 male subjects (47 with adenoma, 34 with early cancer, 17 with advanced cancer, and 26 without tumors as controls). In patients with adenoma, high triglyceride and low adiponectin were associated with a significant increase in the odds ratio (OR) by univariate analysis. Only a low adiponectin level was related to increased adenoma risk, with an adjusted OR for low level (early cancer, high body mass index, high triglyceride, and low adiponectin were associated with a significant increase in OR in univariate analysis. Imultivariate analysis, only low adiponectin was significantly associated with early cancer, with an adjusted OR of 4.495 (95% CI:1.090-18.528, P=0.038). However, in patients with advanced cancer, low adiponectin was not recognized as a significant risk factor for advanced ***: A decreased level of adiponectin is str

关键词： Adenoma early colorectal cancer Metabolic syndrome Adipokines Colonoscopy Resistin Leptin Body mass index

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Endoscopic full-thickness resection using an over-the-scope device:A prospective study

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World Journal of Gastroenterology 2021年第8期27卷 725-736页

作者： Jin-Tao Guo Jing-Jing Zhang Yu-Fan Wu Ye Liao Yi-Dan Wang Bao-Zhen Zhang Sheng Wang Si-Yu Sun Department of Gastroenterology Shengjing Hospital of China Medical UniversityShenyang 110004Liaoning ProvinceChina

BACKGROUND Endoscopic submucosal dissection to treat mucosal and submucosal lesions sometimes results in low rates of microscopically margin-negative(R0)*** full-thickness resection(EFTR)has a high R0 resection rate and allows for the definitive diagnosis and treatment of selected mucosal and submucosal lesions that are not suitable for conventional resection *** To evaluate the efficacy and safety of EFTR using an over-the-scope clip(OTSC).METHODS This prospective,single-center,non-randomized clinical trial was conducted at the endoscopy center of Shengjing Hospital of China Medical *** study included patients aged 18-70 years who had gastric or colorectal submucosal tumors(SMTs)(≤20 mm in diameter)originating from the muscularis propria based on endoscopic ultrasound(EUS)and patients who had early-stage gastric or colorectal cancer(≤20 mm in diameter)based on EUS and computed *** lesions were treated by EFTR combined with an OTSC for wound closure between November 2014 and October *** analyzed patient demographics,lesion features,histopathological diagnoses,R0 resection(negative margins)status,adverse events,and follow-up *** A total of 68 patients(17 men and 51 women)with an average age of 52.0±10.5 years(32-71 years)were enrolled in this study,which included 66 gastric or colorectal SMTs and 2 early-stage colorectal *** mean tumor diameter was 12.6±4.3 *** EFTR procedure was successful in all *** mean EFTR procedure time was 39.6±38.0 *** mean OTSC defect closure time was 5.0±3.8 min,and the success rate of closure for defects was 100%.Histologically complete resection(R0)was achieved in 67(98.5%)***-related adverse events were observed in 11(16.2%)*** average post-procedure length of follow-up was 48.2±15.7 *** was no recurrence during *** EFTR combined with an OTSC is an effective and safe technique for the removal of select sube

关键词： Endoscopic full-thickness resection Over-the-scope clip early gastric cancer early colorectal cancer Submucosal tumor Gastrointestinal stromal tumor

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Development and validation of an online calculator to predict the pathological nature of colorectal tumors

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World Journal of Gastrointestinal Oncology 2023年第7期15卷 1271-1282页

作者： Ya-Dan Wang Jing Wu Bo-Yang Huang Chun-Mei Guo Cang-Hai Wang Hui Su Hong Liu Miao-Miao Wang Jing Wang Li Li Peng-Peng Ding Ming-Ming Meng Department of Gastroenterology Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China Department of Gastroenterology Beijing Friendship HospitalCapital Medical UniversityNational Clinical Research Center for Digestive DiseasesBeijing Digestive Disease CenterBeijing Key Laboratory for Precancerous Lesion of Digestive DiseasesBeijing 100050China Department of Gastroenterology Beijing Shijitan Hospitalthe Ninth Clinical Medicine Peking UniversityBeijing 100038China

BACKGROUND No single endoscopic feature can reliably predict the pathological nature of colorectal tumors(CRTs).AIM To establish and validate a simple online calculator to predict the pathological nature of CRTs based on white-light *** This was a single-center *** the identification stage,530 consecutive patients with CRTs were enrolled from January 2015 to December 2021 as the derivation *** regression analysis was performed.A novel online calculator to predict the pathological nature of CRTs based on white-light images was established and verified *** the validation stage,two series of 110 images obtained using white-light endoscopy were distributed to 10 endoscopists[five highly experienced endoscopists and five less experienced endoscopists(LEEs)]for external validation before and after systematic *** A total of 750 patients were included,with an average age of 63.6±10.4 *** colorectal cancer(ECRC)was detected in 351(46.8%)*** size,left semicolon site,rectal site,acanthosis,depression and an uneven surface were independent risk factors for *** C-index of the ECRC calculator prediction model was 0.906(P=0.225,Hosmer-Lemeshow test).For the LEEs,significant improvement was made in the sensitivity,specificity and accuracy(57.6%vs 75.5%;72.3%vs 82.4%;64.2%vs 80.2%;P<0.05),respectively,after training with the ECRC online calculator prediction *** A novel online calculator including tumor size,location,acanthosis,depression,and uneven surface can accurately predict the pathological nature of ECRC.

关键词： Pathological nature colorectal tumors White-light endoscopy Online calculator early colorectal cancer

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Non-exposed endoscopic wall-inversion surgery with one-step nucleic acid amplification for early gastrointestinal tumors:Personal experience and literature review

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World Journal of Gastroenterology 2023年第24期29卷 3883-3898页

作者： Francesco Crafa Serafino Vanella Aristide Morante Onofrio A Catalano Kelsey L Pomykala Mario Baiamonte Maria Godas Alexandra Antunes Joaquim Costa Pereira Valentina Giaccaglia Division of General and Surgical Oncology St.Giuseppe Moscati HospitalCenter of National Excellence and High SpecialtyAvellino 83100Italy Division of Gastorenterology and Endoscopy St.Giuseppe Moscati HospitalCenter of National Excellence and High SpecialtyAvellino 83100Italy Department of Radiology Athinoula A Martinos Center for Biomedical ImagingMassachusetts General HospitalHarvard Medical SchoolBostonMA 02114United States Department of Nuclear Medicine Department of Radiological SciencesUniversity Hospital EssenUniversity of Duisburg-EssenEssen 45141Germany Department of General Surgery Braga HospitalBraga 4710-243Portugal Department of Surgery Medclinic City HospitalDubai 505004United Arab Emirates

BACKGROUND Laparoscopic and endoscopic cooperative surgery is a safe,organ-sparing surgery that achieves full-thickness resection with adequate *** studies have demonstrated the safety and efficacy of these ***,these techniques are limited by the exposure of the tumor and mucosa to the peritoneal cavity,which could lead to viable cancer cell seeding and the spillage of gastric juice or enteric liquids into the peritoneal ***-exposed endoscopic wallinversion surgery(NEWS)is highly accurate in determining the resection margins to prevent intraperitoneal contamination because the tumor is inverted into the visceral lumen instead of the peritoneal *** intraoperative assessment of the nodal status could allow stratification of the extent of ***-step nucleic acid amplification(OSNA)can provide a rapid method of evaluating nodal tissue,whilst nearinfrared laparoscopy together with indocyanine green can identify relevant nodal tissue *** To determine the safety and feasibility of NEWS in early gastric and colon cancers and of adding rapid intraoperative lymph node(LN)assessment with *** The patient-based experiential portion of our investigations was conducted at the General and Oncological Surgery Unit of the *** Moscati Hospital(Avellino,Italy).Patients with early-stage gastric or colon cancer(diagnosed via endoscopy,endoscopic ultrasound,and computed tomography)were *** lesions were treated by NEWS procedure with intraoperative OSNA assay between January 2022 and October *** were examined intraoperatively with OSNA and postoperatively with conventional *** analyzed patient demographics,lesion features,histopathological diagnoses,R0 resection(negative margins)status,adverse events,and follow-up *** were collected prospectively and analyzed *** A total of 10 patients(5 males and 5 females)with an average age of 70.4±4.5 years(range:62

关键词： Laparoscopic and endoscopic cooperative surgery Non-exposed endoscopic wall inversion surgery early gastric cancer early colorectal cancer Sentinel lymph node One-step nucleic acid amplification Endoscopic full-thickness resection

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Primary signet-ring cell carcinoma of the colon at early stage: A case report and a review of the literature

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World Journal of Gastroenterology 2006年第21期12卷 3446-3449页

作者： Kuang-I Fu Yasushi Sano Shigeharu Kato Hiroki Saito Atsushi Ochiai Takahiro Fujimori Yutaka Saito Takahisa Matsuda Takahiro Fujii Shigeaki Yoshida Division of Gastrointestinal Oncology and Digestive Endoscopy National cancer Center Hospital East KashiwaChiba 277-8577Japan Department of Surgical and Molecular PathologyDokkyo University School of Medicine880 KitakobaysashiMibuShimotugaTochigi 321-0293Japan Division of Gastrointestinal Oncology and Digestive Endoscopy National cancer Center Hospital East KashiwaChiba 277-8577Japan Division of Pathology National cancer Center East Research Institute Chiba 277-8577Japan Department of Surgical and Molecular Pathology Dokkyo University School of Medicine 880 KitakobaysashiMibuShimotugaTochigi 321-0293Japan Division of Endoscopy National cancer Center Hospital TsukijiTokyo 104-0045Japan

A 67-year-old man, who had undergone surgery to resect multiple gastric cancers 4 years ago, visited our hospital for surveillance colonoscopy. Colonoscopy revealed a discolored, 7-mm in diameter, flat-elevated lesion with central depression in the transverse colon near the splenic flexure. Although the findings of endoscopy and barium enema were suggestive of submucosal invasion, the patient chose to undergo endoscopic mucosal resection. Pathological examination of the resected specimen revealed signet-ring cell carcinoma and a positive surgical margin. A second operation was performed, and no residual tumor or metastasis to lymph nodes was found in the resected specimens. Primary colorectal cancers composed of signet-ring cell carcinoma detected and treated at an early stage are extremely rare. We present a case and review the literature.

关键词： Signet-ring cell carcinoma early colorectal cancer Endoscopic mucosal resection

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Balloon overtube-guided colorectal endoscopic submucosal dissection

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World Journal of Gastroenterology 2009年第48期15卷 6086-6090页

作者： Tomohiko Ohya Ken Ohata Kazuki Sumiyama Yousuke Tsuji Ikuro Koba Nobuyuki Matsuhashi Hisao Tajiri Department of Endoscopy The Jikei University School of Medicine Division of Gastroenterology Kanto Medical Center NTT EC Division of Gastroenterology and Hepatology Yamaga Chou Hospital Department of Endoscopy Department of Gastroenterology and HepatologyThe Jikei University School of Medicine

AIM:To evaluate the usefulness of a balloon overtube to assist colorectal endoscopic submucosal dissection(ESD)using a ***:The results of 45 consecutive patients who underwent colorectal ESD were analyzed in a single tertiary endoscopy *** preoperative evaluation of access to the lesion,difficulties were experienced in the positioning and stabilization of a gastroscope in 15 patients who were thus assigned to the balloonguided ESD group.A balloon overtube was placed with a gastroscope to provide an endoscopic channel to the lesion in cases with preoperatively identified difficulties related to *** ESD was performed following standard procedures.A submucosal fluid bleb was created with hyaluronic acid solution.A circumferential mucosal incision was made to marginate the *** isolated lesion was finally excised from the deeper layers with repetitive electrosurgical dissections with needle *** success of colorectal ESD,procedural feasibility,and procedure-related complications were the main outcomes and ***:The overall en bloc excision rate of colorectal ESD during this study at our institution was 95.6%.En bloc excision of the lesion was successfully achieved in 13 of the 15 patients(86.7%)in the balloon overtube-guided colorectal ESD group,which was comparable to the results of the standard ESD group with better accessibility to the lesion(30/30,100%,not statistically significant).CONCLUSION:Use of a balloon overtube can improve access to the lesion and facilitate scope manipulation for colorectal ESD.

关键词： Balloon overtube colorectal neoplasm early colorectal cancer En bloc tumor excision Endoscopic submucosal dissection Laterally spreading tumor

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colorectal endoscopic submucosal dissection from a Westernperspective:Today's promises and future challenges

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World Journal of Gastrointestinal Endoscopy 2016年第2期8卷 40-55页

作者： JoséCarlos Marín-Gabriel Gloria Fernández-Esparrach JoséDíaz-Tasende Alberto Herreros de Tejada Department of Gastroenterology Endoscopy UnitHigh Risk GI Cancer Clinici+12Hospital Universitario“12 de Octubre”28041 MadridSpain Department of Gastroenterology Endoscopy UnitCIBEREHDIDIBAPSHospital ClínicUniversidad de Barcelona08036 BarcelonaSpain Department of Gastroenterology IDIPHIMHospital Universitario Puerta de HierroMajadahonda28222 MadridSpai

Over the last few years, endoscopic submucosal dissection(ESD) has shown to be effective in the management of early colorectal neoplasms, particularly in Asian countries where the technique was born. In the Western world, its implementation has been slow and laborious. In this paper, the indications for ESD, its learning model, the available methods to predict the presence of deep submucosal invasion before the procedure and the published outcomes from Asia and Europe will be reviewed. Since ESD has several limitations in terms of learning achievement in the West, and completion of the procedure for the first cases is difficult in our part of the world, a short review on colorectal assisted ESD has been included. Finally, other endoscopic and surgical treatment modalities that are in competition with colorectal ESD will be summarized.

关键词： Endoscopic submucosal dissection Endoscopic full-thickness resection Endoscopic mucosal resection Hybrid endoscopic submucosal dissection early colorectal cancer Assisted endoscopic submucosal dissection Magnification chromoendoscopy colorectal surgery colorectal neoplasm Submucosal invasion Predictive factors Training Learning curve

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