Original articleClinical endoscopyClinical outcomes and factors related to resectability and curability of EMR for early colorectal cancer
Section snippets
Patients
All EMRs for ECC performed at Severance Hospital, Yonsei University School of Medicine, between March 1997 and August 2007 were initially considered for enrollment in this study. Patients with synchronous advanced colorectal cancers, familial colorectal cancers, and inflammatory bowel diseases were excluded. Pre- and post-EMR clinicopathologic data were collected retrospectively. ECC was defined according to the Japanese classification of colorectal carcinoma8 as limited to the mucosa or
EMR
Second-stage planned endoscopic resection was performed on 208 (88.1%) cases, whereas only 28 (11.9%) cases were endoscopically resected at the time of initial identification. Endoscopic resection was performed with or without saline solution-epinephrine injection at the discretion of the endoscopist. Usually, injection was used for flat, depressed, or protruding lesion types but not for pedunculated lesions. In cases of endoscopic piecemeal mucosal resection, endoscopists attempted to take
Baseline characteristics of study patients
A total of 236 lesions from 231 patients were included in the study. The number of cancerous lesions was 1 in 226 patients (97.8%) and 2 in 5 patients (2.2%). The baseline characteristics of the patients and the tumors are summarized in Table 1. Forty-two cases (17.8%) were lost to follow-up. Among patients with more than a year of follow-up, the median follow-up period was 42.1 months (range 12.4-123.1 months; interquartile range [IQR] 27.1-54.5 months).
Techniques of EMR
EMR included snaring polypectomy without
Discussion
EMR has emerged as a curative treatment for colorectal cancer in the mucosa or with superficial invasion of the submucosa.14 There have been many studies evaluating the efficacy and safety of EMR for ECC.10, 15, 16, 17, 18, 19, 20 However, most of these studies have limitations in terms of the small number of ECC cases and the varying criteria for complete cure between studies. Therefore, clinicopathologic factors associated with resectability and curability of endoscopic resection for ECC have
References (38)
- et al.
Increasing incidence of colorectal cancer in Asia: implications for screening
Lancet Oncol
(2005) - et al.
Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology
Gastroenterology
(2008) - et al.
State of the art on endoscopic mucosal resection and endoscopic submucosal dissection
Gastrointest Endosc Clin N Am
(2007) - et al.
Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm
Gastrointest Endosc
(2001) - et al.
Endoscopic piecemeal resection with submucosal saline injection of large sessile colorectal polyps
Gastrointest Endosc
(2000) - et al.
Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization
Gastrointest Endosc
(2007) - et al.
Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases
Clin Gastroenterol Hepatol
(2007) - et al.
Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video)
Gastrointest Endosc
(2007) - et al.
Flat and depressed types of early colorectal cancers: from East to West
Gastrointest Endosc Clin N Am
(2008) - et al.
Cancer statistics, 2010
CA Cancer J Clin
(2010)
Epidemiology of colorectal cancer: the 21-year experience of a specialised registry
Intern Emerg Med
Screening for early colorectal cancer
World J Surg
Review article: Population screening for colorectal cancer
Aliment Pharmacol Ther
Early detection of and screening for colorectal neoplasia
Gut Liver
Endoscopic findings and management
Endoscopic mucosal resection for early colorectal neoplasia: pathologic basis, procedures, and outcomes
Dis Colon Rectum
Endoscopic mucosal resection of flat and depressed types of early colorectal cancer
Endoscopy
Overview of colorectal cancer in Japan: report from the Registry of the Japanese Society for Cancer of the Colon and Rectum
Dis Colon Rectum
The Vienna classification of gastrointestinal epithelial neoplasia
Gut
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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
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