Investigation of clinicopathological features and indication of endoscopic resection in young patients with intramucosal early gastric cancer / 中国肿瘤临床

Objective: To investigate clinicopathological features, risk of lymph node metastasis, and indications of endoscopic submu-cosal dissection (ESD) in young patients with intramucosal early gastric cancer (EGC). Methods: In total, 325 EGC patients who under-went radical gastrectomy and had complete clinicopathological data in Anhui Provincial Hospital from March 2009 to December 2016 were retrospectively evaluated. All patients were confirmed to have intramucosal cancer based on their postoperative pathology re-sults. The patients were assigned into two groups according to their age: young group (≤40 years) and old group (>40 years). The clini-copathological features and safety of ESD in the youth group were analyzed. Results: Among all patients with intramucosal EGC, 30 (9.2%) were in the youth group. Intramucosal cancer in the youth group occurred predominantly in women, and the pathological types were mainly undifferentiated and mixed, which were more likely to metastasize to the lymph nodes. In the youth group, EGC patients with intramucosal differentiated type, who had ESD indications, had no risk of lymph node metastasis. However, the rate of lymph node metastasis was up to 25% in intramucosal undifferentiated-type EGC patients who had expanded ESD indications. Conclusions:Young patients with intramucosal EGC have poor pathological differentiation and strong invasiveness, and ESD may be considered for the treatment of differentiated intramucosal cancer.

Unusual Local Recurrence with Distant Metastasis after Successful Endoscopic Submucosal Dissection for Colorectal Mucosal Cancer

Intramucosal colorectal cancer (CRC) is thought not to metastasize because the colonic lamina propria lacks lymphatics. Only a few recent case reports have suggested lymph node metastasis from intramucosal CRC, but there is no clear evidence supporting the metastatic potential of intramucosal CRC. Hence, endoscopic resection is regarded as curative treatment for intramucosal CRC. This report describes two cases of unusual local recurrence with distant metastasis in patients who had previously undergone successful endoscopic submucosal dissection for intramucosal CRC. The recurrent colorectal lesions developed at the site of the previous endoscopic submucosal dissection scars in a relatively short-term period, and the pathologic findings showed an “undermining” invasion pattern without surrounding mucosal change. Based on the clinical course and pathological findings, we concluded that the second colorectal lesions were recurrences rather than de novo cancers.

Diagnostic Coding for Intramucosal Carcinoma and Neuroendocrine Tumor in the Colorectum: Proposal for Avoiding Confusing Coding in Korea

Applying proper coding is important for doctors practicing gastroenterology. The coding systems established by various organizations define tumors differently. As a result of changing concepts of tumor classification, there are coding and reimbursement issues following the confirmation of malignant lesions by nationwide cancer screening in patients with intramucosal carcinoma and neuroendocrine tumors of the colorectum. In addition, there have been discrepancies between the views of endoscopists and pathologists regarding tumor coding. The Korean Society of Gastrointestinal Endoscopy held an expert meeting and established a consensus for the coding of intramucosal carcinoma and neuroendocrine tumor of the colorectum.

Diagnostic Coding for Intramucosal Carcinoma and Neuroendocrine Tumor in the Colorectum: Proposal for Avoiding Confusing Coding in Korea

Applying proper coding is important for doctors practicing gastroenterology. The coding systems established by various organizations define tumors differently. As a result of changing concepts of tumor classification, there are coding and reimbursement issues following the confirmation of malignant lesions by nationwide cancer screening in patients with intramucosal carcinoma and neuroendocrine tumors of the colorectum. In addition, there have been discrepancies between the views of endoscopists and pathologists regarding tumor coding. The Korean Society of Gastrointestinal Endoscopy held an expert meeting and established a consensus for the coding of intramucosal carcinoma and neuroendocrine tumor of the colorectum.

Evaluation of endoscopic submucosal dissection for early tumors located at the esophagogastric junction / 中华消化外科杂志

Objective To assess the value of endoscopic submucosal dissection(ESD)for the treatment of early tumors located at the esophagogastric junction.Methods The clinical data of 57 patients with early tumors located at the esophagogastric junction who received ESD at the Zhongshan Hospital from November 2006to March 2011 were retrospectively analyzed.The operation time,blood loss,resection of tumor and perioperative complications were observed.The pre-and postoperative pathological findings were analyzed.Results ESD was successfully completed on the 57 patients.The median operation time was 55 minutes(range,25-95 minutes),and the median volume of blood loss was 74 ml(range,20-300 ml).En-bloc and piecemeal resections were carried out on 39 and 18 patients,respectively.The operative complication rate was 25%(14/57),including 5 patients complicated with perforation and 9 with bleeding.The postoperative complication rate was 16%(9/57),including 6 patients complicated with delayed hemorrhage and 3 with stricture of the esophagogastric junction.Of the 39 patients who were diagnosed as with high-level intraepithelial neoplasia preoperatively.3 were confirmed as with intramucosal carcinoma;of the 18 patients who were diagnosed as with intramucosal carcinoma preoperatively,4 were confirmed ag with adenocarcinoma.All patients were followed up for 9-27 months,no recurrence or metastasis was found.Conclusion ESD is effective and safe for the treatment of early tumors located at the esopha gogastric junction.

Investigation of endoscopic local treatment for colorectal intramucosal carcinoma / 重庆医科大学学报

Objective:To investigate the effects of endoscopic local treatment for colorectal intramucosal carcinoma.Methods:42 patients with colorectal intramucosal carcinoma were treated with endoscopic local through one or few methods such as biopsy forceps resection,looping ligature and high frequency electric coagulation etc.in past five years.Results:(1)18 cases received biopsy forceps resection,3 cases received looping ligature,16cases received high frequency electric coagulatio resection,5 cases received many kinds of methods.(2)3 cases of 5 cases with advanced carcinoma were operated enlarge radical surgery except 1 cases who refused operation and 1 cases who losted operation opportunity.In the rest 37 cases,7cases were operated surgery,malignant remnants were no founded in theses colon specimens.(3)The following-up 33cases(30 cases without surgery)failed to show recurrent cancer for 1 month to 5 years.(4)In the following-up cases,the incidence of neogenesis adenoma was 57.1% in cancer with pilosity adenoma and was 15.8% in early cancer without adenoma during 1 year to 3 years after operation.Conclusions:It can achieve to healing,security and minimum invasive treatment for endoscopic local resection to colorectal intramucosal carcinoma as long as it is suitable to select case.