Skip to main content

Advertisement

SpringerLink
Log in

Risk factors for vertical incomplete resection in endoscopic submucosal dissection as total excisional biopsy for submucosal invasive colorectal carcinoma

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Endoscopic submucosal dissection (ESD) for colorectal tumor is a minimally invasive treatment. Histologic information obtained from the entire ESD specimen is important for therapy selection in submucosal invasive colorectal carcinoma (SMca). This study aimed to identify risk factors for vertical incomplete resection (vertical margin-positive [VM+]) when ESD was performed as total excisional biopsy for SMca.

Methods

From June 2003 through December 2011, 78 SMca cases were resected by ESD at Hiroshima University Hospital. Patient and tumor characteristics, intraoperative variables, and histopathology were compared between the VM+ group and the vertical complete resection (vertical margin-negative) group. The ability of magnifying endoscopy (ME) and endoscopic ultrasonography (EUS) to predict VM+ was assessed.

Results

ESD resulted in VM+ in eight cases (10.3 %), with a greater percentage invading to a depth of ≥2,000 vs. <2,000 μm (P = 0.047). Severe submucosal fibrosis was found in five of the eight cases (62.5 %, P = 0.017). Poor differentiation was seen at the deepest invasive portion in six cases (75.0 %), and two of six cases had an invasion depth <2,000 μm. Of 39 EUS cases, 36 not showing deep invasion close to the muscularis propria were completely resected by ESD.

Conclusions

Submucosal fibrosis and poor differentiation at the deepest invasive portion may be risk factors for VM+ in colorectal ESD for tumors with submucosal deep invasion. ME plus EUS is more likely to help determine whether ESD is indicated as complete total excisional biopsy for SMca.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Matsuda T, Marugame T, Kamo K, Katanoda K, Ajiki W, Sobue T (2012) Cancer incidence and incidence rates in Japan in 2006: based on data from 15 population-based cancer registries in the Monitoring of Cancer Incidence in Japan (MCIJ) project. Jpn J Clin Oncol 42:139–147

    Article  PubMed  Google Scholar 

  2. Macafee DAL, Waller M, Whynes DK, Moss S, Scholefield JH (2008) Population screening for colorectal cancer: the implications of an ageing population. Br J Cancer 99:1991–2000

    Article  PubMed  CAS  Google Scholar 

  3. Stock C, Pulte D, Haug U, Brenner H (2012) Subsite-specific colorectal cancer risk in the colorectal endoscopy era. Gastrointest Endosc 75:621–630

    Article  PubMed  Google Scholar 

  4. Shatney CH, Lober PH, Gilbertsen VA, Sosin H (1974) The treatment of pedunculated adenomatous colorectal polyps with focal cancer. Surg Gynecol Obstet 139:845–850

    PubMed  CAS  Google Scholar 

  5. Shinya H, Cooperman A, Wolff WI (1982) A rationale for the endoscopic management of colonic polyps. Surg Clin North Am 62:861–867

    PubMed  CAS  Google Scholar 

  6. Christie JP (1988) Polypectomy or colectomy? Management of 106 consecutively encountered colorectal polyps. Am Surg 54:93–99

    PubMed  CAS  Google Scholar 

  7. Conte CC, Welch JP, Tennant R, Forouhar F, Bloom GP (1987) Management of endoscopically removed malignant colon polyps. J Surg Oncol 36:116–121

    Article  PubMed  CAS  Google Scholar 

  8. Kyzer S, Begin LR, Gordon PH, Mitmarker B (1992) The care of patients with colorectal polyps that contain invasive adenocarcinoma. Endoscopic polypectomy or colectomy? Cancer 70:2044–2050

    Article  PubMed  CAS  Google Scholar 

  9. Minamoto T, Mai M, Ogino T, Sawaguchi K, Ohta T, Fujimoto T, Takahashi Y (1993) Early invasive colorectal carcinomas metastatic to the lymph node with attention to their nonpolypoid development. Am J Gastroenterol 88:1035–1039

    PubMed  CAS  Google Scholar 

  10. Tanaka S, Yokota T, Saito D, Okamoto S, Oguro Y, Yoshida S (1995) Clinicopathologic features of early rectal carcinoma and indications for endoscopic treatment. Dis Colon Rectum 38:959–963

    Article  PubMed  CAS  Google Scholar 

  11. Tanaka S, Haruma K, Teixeira CR, Tatsuta S, Ohtsu N, Hiraga Y, Yoshihara M, Sumii K, Kajiyama G, Shimamoto F (1995) Endoscopic treatment of submucosal invasive colorectal carcinoma with special reference to risk factors for lymph node metastasis. J Gastroenterol 30:710–717

    Article  PubMed  CAS  Google Scholar 

  12. Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H, Ishiguro M, Kanemitsu Y, Kokudo N, Muro K, Ochiai A, Oguchi M, Ohkura Y, Saito Y, Sakai Y, Ueno H, Yoshino T, Fujimori T, Koinuma N, Morita T, Nishimura G, Sakata Y, Takahashi K, Takiuchi H, Tsuruta O, Yamaguchi T, Yoshida M, Yamaguchi N, Kotake K, Sugihara K (2012) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol 17:1–29

    Article  PubMed  Google Scholar 

  13. Matsumoto A, Tanaka S, Oba S, Kanao H, Oka S, Yoshihara M, Chayama K (2010) Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis. Scand J Gastroenterol 45:1329–1337

    Article  PubMed  Google Scholar 

  14. Terasaki M, Tanaka S, Oka S, Nakadoi K, Takata S, Kanao H, Yoshida S, Chayama K (2012) Clinical outcomes of endoscopic submucosal dissection and endoscopic mucosal resection for laterally spreading tumors larger than 20 mm. J Gastroenterol Hepatol 27:734–740

    Article  PubMed  Google Scholar 

  15. Hurlstone DP, Atkinson R, Sanders DS, Thomson M, Cross SS, Brown S (2007) Achieving R0 resection in the colorectum using endoscopic submucosal dissection. Br J Surg 94:1536–1542

    Article  PubMed  CAS  Google Scholar 

  16. Tamegai Y, Saito Y, Masaki N, Hinohara C, Oshima T, Kogure E, Liu Y, Uemura N, Saito K (2007) Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy 39:418–422

    Article  PubMed  CAS  Google Scholar 

  17. Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S, Yamamichi N, Tateishi A, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M (2007) Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases. Clin Gastroenterol Hepatol 5:678–683

    Article  PubMed  Google Scholar 

  18. Zhou PH, Yao LQ, Qin XY (2009) Endoscopic submucosal dissection for colorectal epithelial neoplasm. Surg Endosc 23:1546–1551

    Article  PubMed  Google Scholar 

  19. Isomoto H, Nishiyama H, Yamaguchi N, Fukuda E, Ishii H, Ikeda K, Ohnita K, Nakao K, Kohno S, Shikuwa S (2009) Clinicopathological factors associated with clinical outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy 41:679–683

    Article  PubMed  CAS  Google Scholar 

  20. Saito Y, Sakamoto T, Fukunaga S, Nakajima T, Kiriyama S, Matsuda T (2009) Endoscopic submucosal dissection (ESD) for colorectal tumors. Dig Endosc 21:S7–S12

    Article  PubMed  Google Scholar 

  21. Iizuka H, Okamura S, Onozato Y, Ishihara H, Kakizaki S, Mori M (2009) Endoscopic submucosal dissection for colorectal tumors. Gastroenterol Clin Biol 33:1004–1011

    Article  PubMed  CAS  Google Scholar 

  22. Hotta K, Oyama T, Shinohara T, Miyata Y, Takahashi A, Kitamura Y, Tomori A (2010) Learning curve for endoscopic submucosal dissection of large colorectal tumors. Dig Endosc 22:302–306

    Article  PubMed  Google Scholar 

  23. Niimi K, Fujishiro M, Kodashima S, Goto O, Ono S, Hirano K, Minatsuki C, Yamamichi N, Koike K (2010) Long-term outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy 42:723–729

    Article  PubMed  CAS  Google Scholar 

  24. Yoshida N, Naito Y, Kugai M, Inoue K, Wakabayashi N, Yagi N, Yanagisawa A, Yoshikawa T (2010) Efficient hemostatic method for endoscopic submucosal dissection of colorectal tumors. World J Gastroenterol 16:4180–4186

    Article  PubMed  Google Scholar 

  25. Toyonaga T, Man-I M, Fujita T, East JE, Nishino E, Ono W, Morita Y, Sanuki T, Yoshida M, Inokuchi H, Azuma T (2010) Retrospective study of technical aspects and complications of endoscopic submucosal dissection for laterally spreading tumors of the colorectum. Endoscopy 42:714–722

    Article  PubMed  CAS  Google Scholar 

  26. Uraoka T, Higashi R, Kato J, Kaji E, Suzuki H, Ishikawa S, Akita M, Hirakawa T, Saito S, Hori K, Kawahara Y, Mead RJ, Yamamoto K (2011) Colorectal endoscopic submucosal dissection for elderly patients at least 80 years of age. Surg Endosc 25:3000–3007

    Article  PubMed  Google Scholar 

  27. Sunouchi K, Namiki K, Mori M, Shimizu T, Tadokoro M (2000) How should patients 80 years of age or older with colorectal carcinoma be treated? Long-term and short-term outcome and postoperative cytokine levels. Dis Colon Rectum 43:233–241

    Article  PubMed  CAS  Google Scholar 

  28. Etzioni DA, Beart RW, Madoff RD, Ault GT (2009) Impact of the aging population on the demand for colorectal procedures. Dis Colon Rectum 52:583–590

    Article  PubMed  Google Scholar 

  29. Nakadoi K, Tanaka S, Kanao H, Terasaki M, Takata S, Oka S, Yoshida S, Arihiro K, CHayama K (2012) Management of T1 colorectal carcinoma with special reference to criteria for curative endoscopic resection. J Gastroenterol Hepatol 27:1057–1062

    Article  PubMed  Google Scholar 

  30. Kudo S, Hirota S, Nakajima T, Hosobe S, Kusaka H, Kobayashi T, Himori M, Yagyuu A (1994) Colorectal tumors and pit pattern. J Clin Pathol 47:880–885

    Article  PubMed  CAS  Google Scholar 

  31. Tanaka S, Kaltenbach T, Chayama K, Soetikno R (2006) High-magnification colonoscopy (with videos). Gastrointest Endosc 64:604–613

    Article  PubMed  Google Scholar 

  32. Kudo S, Kurahashi T, Kashida H (2004) Diagnosis of depth of invasion of colorectal lesions using magnifying colonoscopy. Stomach Intestine 39:47–52 [in Japanese with English abstract]

    Google Scholar 

  33. Kanao H, Tanaka S, Oka S, Hirata M, Yoshida S, Chayama K (2009) Narrow-band imaging magnification predicts the histology and invasion depth of colorectal tumors. Gastrointest Endosc 69:631–636

    Article  PubMed  Google Scholar 

  34. Tanaka S, Tamegai Y, Tsuda S, Saito Y, Yahagi N, Yamano HO (2010) Multicenter questionnaire survey on the current situation of colorectal endoscopic submucosal dissection in Japan. Dig Endosc 22:S2–S8

    Article  PubMed  Google Scholar 

  35. Tanaka S, Oka S, Kaneko I, Hirata M, Mouri R, Kanao H, Yoshida S, Chayama K (2007) Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc 66:100–107

    Article  PubMed  Google Scholar 

  36. Tanaka S, Oka S, Chayama K (2008) Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection. J Gastroenterol 43:641–651

    Article  PubMed  Google Scholar 

  37. Bosman FT, Carneiro F, Hruban RH, Theise ND (2010) WHO classification of tumours of the digestive system, 4th edn. IARC, Lyon

    Google Scholar 

  38. Kobayashi Y, Kudo S, Miyachi H, Hosoya T, Ikehara N, Ohtsuka K, Kashida H, Hamatani S, Hinotsu S, Kawakami K (2011) Clinical usefulness of pit patterns for detecting colonic lesions requiring surgical treatment. Int J Colorectal Dis 26:1531–1540

    Article  PubMed  Google Scholar 

  39. Kanao H, Tanaka S, Oka S, Kaneko I, Yoshida S, Arihiro K, Yoshihara M, Chayama K (2008) Clinical significance of type VI pit pattern subclassification in determining the depth of invasion of colorectal neoplasms. World J Gastroenterol 14:211–217

    Article  PubMed  Google Scholar 

  40. Wada Y, Kudo SE, Kashida H, Ikehara N, Inoue H, Yamamura F, Ohtsuka K, Hamatani S (2009) Diagnosis of colorectal lesions with the magnifying narrow-band imaging system. Gastrointest Endosc 70:522–531

    Article  PubMed  Google Scholar 

  41. Tanaka S, Yoshida S, Chayama K (2004) Clinical usefulness of high-frequency ultrasound probes for new invasion depth diagnosis in submucosal colorectal carcinoma. Gastrointest Endosc 16:S161–S164

    Google Scholar 

  42. Mouri R, Yoshida S, Tanaka S, Oka S, Yoshihara M, Chayama K (2009) Usefulness of endoscopic ultrasonography in determining the depth of invasion and indication for endoscopic treatment of early gastric cancer. J Clin Gastroenterol 43:318–322

    Article  PubMed  Google Scholar 

  43. Matsumoto Y, Yanai H, Tokiyama H, Nishiaki M, Higaki S, Okita K (2000) Endoscopic ultrasonography for diagnosis of submucosal invasion in early gastric cancer. J Gastroenterol 35:326–331

    Article  PubMed  CAS  Google Scholar 

  44. Yanai H, Noguchi T, Mizumachi S, Tokiyama H, Nakamura H, Tada M, Okita K (1999) A blind comparison of the effectiveness of endoscopic ultrasonography and endoscopy in staging early gastric cancer. Gut 44:361–365

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Endoscopy, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Shun-ichiro Ozawa, Shinji Tanaka, Nana Hayashi, Hiroyuki Kanao, Shiro Oka & Shigeto Yoshida

  2. Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan

    Shinji Tanaka, Soki Nishiyama, Motomi Terasaki, Koichi Nakadoi & Kazuaki Chayama

Authors
  1. Shun-ichiro Ozawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shinji Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nana Hayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Soki Nishiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Motomi Terasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Koichi Nakadoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hiroyuki Kanao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shiro Oka
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shigeto Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kazuaki Chayama
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shinji Tanaka.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ozawa, Si., Tanaka, S., Hayashi, N. et al. Risk factors for vertical incomplete resection in endoscopic submucosal dissection as total excisional biopsy for submucosal invasive colorectal carcinoma. Int J Colorectal Dis 28, 1247–1256 (2013). https://doi.org/10.1007/s00384-013-1701-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-013-1701-1

Keywords

Search

Navigation