Clinical outcomes of positive resection margin after endoscopic mucosal resection of early colon cancers

BACKGROUND/AIMS: When determining the subsequent management after endoscopic resection of the early colon cancer (ECC), various factors including the margin status should be considered. This study assessed the subsequent management and outcomes of ECCs according to margin status.METHODS: We examined the data of 223 ECCs treated by endoscopic mucosal resection (EMR) from 215 patients during 2004 to 2014, and all patients were followed-up at least for 2 years.RESULTS: According to histological analyses, the margin statuses of all lesions after EMR were as follows: 138 cases (61.9%) were negative, 65 cases (29.1%) were positive for dysplastic cells on the resection margins, and 20 cases (8.9%) were uncertain. The decision regarding subsequent management was affected not only by pathologic outcomes but also by the endoscopist’s opinion on whether complete resection was obtained. Surgery was preferred if the lesion extended to the submucosa (odds ratio [OR], 25.46; 95% confidence interval [CI], 7.09–91.42), the endoscopic resection was presumed incomplete (OR, 15.55; 95% CI, 4.28–56.56), or the lymph system was invaded (OR, 13.69; 95% CI, 1.76–106.57). Fourteen patients (6.2%) had residual or recurrent malignancies at the site of the previous ECC resection and were significantly associated with presumed incomplete endoscopic resection (OR, 4.59; 95% CI, 1.21–17.39) and submucosal invasion (OR, 5.14; 95% CI, 1.18–22.34).CONCLUSIONS: Subsequent surgery was associated with submucosa invasion, lymphatic invasion, and cancer-positive margins. Presumed completeness of the resection may be helpful for guiding the subsequent management of patients who undergo endoscopic resection of ECC.

A Rare Case of a Signet Ring Cell Carcinoma of the Colon Mimicking a Juvenile Polyp

Primary signet ring cell carcinoma (SRC) of colon at early stage is quite rare. Only 26 cases were reported until now. We report an early stage of primary SRC which was misdiagnosed as a juvenile polyp and treated with polypectomy followed by surgical resection. A 21-year-old male was administered for hematochezia. Abdominopelvic enhanced computed tomography revealed a polyp with active bleeding at the proximal rectum just below the rectosigmoid junction. Colonoscopy examination revealed a colon polyp with 0.5 cm sized head. Polypectomy was performed with snare and the polyp was completely removed. Biopsy revealed SRC. Surgical resection was also performed and there were no residual tumor or lymph node metastasis in the surgical specimen.

Endoscopic therapy of early colon cancer / 대한내과학회지

The detection of early colon cancer has increased since the advent of screening colonoscopy. Endoscopic resection can be performed to cure early colon cancer with no metastasis. Therefore, we should correctly predict the possibility of metastasis before a trial of endoscopic resection. Metastasis may be assessed using chromoscopy with magnification, narrow band imaging, and endoscopic ultrasound, as well as with conventional imaging studies such as computed tomography (CT) and magnetic resonance imaging (MRI). Various endoscopic resection techniques, including endoscopic submucosal dissection, can be performed to resect early colon cancer. The histopathological evaluation of endoscopically resected early colon cancer can provide clinicians with further information about the risk of regional lymph node metastasis. The decision to perform additional surgery is based on the histopathological examination of the resected specimens.

Analysis of Endoscopic Features of Early Colon Cancer / 대한소화기내시경학회지

The prevalence of colon cancer is increasing in Korea and the principal strategy of its management is early detection and surgical resection. For the early detection of colon cancer, endoscopic evaluation is important and the ability to find out early stage small lesion is needed for the endoscopist. To find out encloscopic features of early colon cancer, we reviewed 17 cases of early colon cancer who have admitted to Seoul National University Hospital from January 1982 to December 1993. 1)59% of the lesions were located in rectum and the size ranged from 0.7cm to 9cm, all of the 17 cases showed polypoid mass contour and the surface of them had erosion, hyperemia, ulceration and easy touch bleeding tendency. 2) Colon cancer was diagnosed by endoscopic gross findings in 41% and endoscopic biopsy could confirm colon cancer in 70%. However, barium enema could diagnose only 41% of early colon cancer. 3) Five cases were operated under the diagnosis of colonic adenoma which were large(>3 cm) villous type or contained severe dysplasia 4) Submucosal tumor infiltration was found in 10 cases and 65% had associated adenoma 5) Lymph node involvement was none and there was no recurrence in 47 month follow up period after various surgical treatments.