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International Journal of Colorectal Disease

Published in:

01-01-2013 | Original Article

Colorectal lateral spreading tumor subtypes: clinicopathology and outcome of endoscopic submucosal dissection

Authors: Mei-Dong Xu, Xiao-Yun Wang, Quan-Lin Li, Ping-Hong Zhou, Yi-Qun Zhang, Yun-Shi Zhong, Wei-Feng Chen, Li-Li Ma, Wen-Zheng Qin, Jian-Wei Hu, Li-Qing Yao

Published in: International Journal of Colorectal Disease | Issue 1/2013

Abstract

Purpose

This study aims to investigate the clinicopathological features of specific subtypes of laterally spreading tumor (LST) and assessed the outcome of endoscopic submucosal dissection (ESD) based upon subdifferentiation status.

Methods

A total of 137 LSTs were present in 135 patients; 96 were granular and 41 exhibited a nongranular pattern. Granular LSTs, subdivided into homogeneous and nodular mixed, and nongranular LSTs, subdivided into flat-elevated and pseudodepressed, were retrospectively evaluated with respect to clinicopathological features and results of ESD (en bloc R0 curative resection, procedure time, complication, and recurrence rate) according to specific subtype.

Results

The distribution of high-grade intraepithelial neoplasia and submucosal carcinomas was more prominent among granular nodular mixed tumors than among granular homogeneous tumors (P = 0.007), whereas there was no significant difference between nongranular pseudodepressed tumors and flat-elevated tumors. The frequency of en bloc R0 curative resection did not differ significantly among specific subtypes. For nodular mixed and pseudodepressed lesions, the median tumor size was significantly larger (P < 0.001 for each) and mean procedure time was also longer (P < 0.05 for each) than for the other two subtypes. All complications, which included three perforations, five episodes of postoperative bleeding, and one recurrence, occurred in granular nodular mixed and nongranular pseudodepressed tumors.

Conclusion

The risk of cancer varies with the subtypes of LSTs. ESD is an effective treatment for LSTs, however ESD is more technically demanding and carries more complications in pseudodepressed and granular mixed subtypes.

Tischendorf JJ, Wasmuth HE, Koch A, Hecker H, Trautwein C, Winograd R (2007) Value of magnifying chromoendoscopy and narrow band imaging (NBI) in classifying colorectal polyps: a prospective controlled study. Endoscopy 39:1092–1096PubMedCrossRef

Konishi K, Kaneko K, Kurahashi T, Yamamoto T, Kushima M, Kanda A, Tajiri H, Mitamura K (2003) A comparison of magnifying and nonmagnifying colonoscopy for diagnosis of colorectal polyps: a prospective study. Gastrointest Endosc 57:48–53PubMedCrossRef

Kato S, Fujii T, Koba I, Sano Y, Fu KI, Parra-Blanco A, Tajiri H, Yoshida S, Rembacken B (2001) Assessment of colorectal lesions using magnifying colonoscopy and mucosal dye spraying: can significant lesions be distinguished? Endoscopy 33:306–310PubMedCrossRef

Tsuda S, Veress B, Toth E, Fork FT (2002) Flat and depressed colorectal tumours in a southern Swedish population: a prospective chromoendoscopic and histopathological study. Gut 51:550–555PubMedCrossRef

Rembacken BJ, Fujii T, Cairns A, Dixon MF, Yoshida S, Chalmers DM, Axon AT (2000) Flat and depressed colonic neoplasms: a prospective study of 1,000 colonoscopies in the UK. Lancet 355:1211–1214PubMedCrossRef

Saitoh Y, Waxman I, West AB, Popnikolov NK, Gatalica Z, Watari J, Obara T, Kohgo Y, Pasricha PJ (2001) Prevalence and distinctive biologic features of flat colorectal adenomas in a North American population. Gastroenterology 120:1657–1665PubMedCrossRef

Shimoda T, Ikegami M, Fujisaki J, Matsui T, Aizawa S, Ishikawa E (1989) Early colorectal carcinoma with special reference to its development de novo. Cancer 64:1138–1146PubMedCrossRef

Sakashita M, Aoyama N, Maekawa S, Kuroda K, Shirasaka D, Ichihara T, Kuroda Y, Minami R, Maeda S, Kasuga M (2000) Flat-elevated and depressed, subtypes of flat early colorectal cancers, should be distinguished by their pathological features. Int J Colorectal Dis 15:275–281PubMedCrossRef

O'Brien MJ, Winawer SJ, Zauber AG, Bushey MT, Sternberg SS, Gottlieb LS, Bond JH, Waye JD, Schapiro M (2004) Flat adenomas in the National Polyp Study: is there increased risk for high-grade dysplasia initially or during surveillance? Clin Gastroenterol Hepatol 2:905–911PubMedCrossRef

10.

Rozen P, Brazowski E (2003) Flat colorectal neoplasia: identification, pathogenesis and clinical significance. Dig Liver Dis 35:135–137PubMedCrossRef

11.

Kim WH, Suh JH, Kim TI, Shin SK, Paik YH, Chung HW, Kim DY, Jeong JH, Kang JK, Kim H, Kim NK (2003) Colorectal flat neoplasia. Dig Liver Dis 35:165–171PubMedCrossRef

12.

Ross AS, Waxman I (2006) Flat and depressed neoplasms of the colon in Western populations. Am J Gastroenterol 101:172–180PubMedCrossRef

13.

Kudo S (1993) Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 25:455–461PubMedCrossRef

14.

Kudo S, Lambert R, Allen JI, Fujii H, Fujii T, Kashida H, Matsuda T, Mori M, Saito H, Shimoda T, Tanaka S, Watanabe H, Sung JJ, Feld AD, Inadomi JM, O'Brien MJ, Lieberman DA, Ransohoff DF, Soetikno RM, Triadafilopoulos G, Zauber A, Teixeira CR, Rey JF, Jaramillo E, Rubio CA, Van Gossum A, Jung M, Vieth M, Jass JR, Hurlstone PD (2008) Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc 68:S3–S47PubMedCrossRef

15.

Uraoka T, Saito Y, Matsuda T, Ikehara H, Gotoda T, Saito D, Fujii T (2006) Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut 55:1592–1597PubMedCrossRef

16.

Matsuda T, Gotoda T, Saito Y, Nakajima T, Conio M (2010) Our perspective on endoscopic resection for colorectal neoplasms. Gastroenterol Clin Biol 34:367–370PubMedCrossRef

17.

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 39:418–422PubMedCrossRef

18.

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

19.

Han KS, Sohn DK, Choi DH, Hong CW, Chang HJ, Lim SB, Choi HS, Jeong SY, Park JG (2008) Prolongation of the period between biopsy and EMR can influence the nonlifting sign in endoscopically resectable colorectal cancers. Gastrointest Endosc 67:97–102PubMedCrossRef

20.

Ishiguro A, Uno Y, Ishiguro Y, Munakata A, Morita T (1999) Correlation of lifting versus non-lifting and microscopic depth of invasion in early colorectal cancer. Gastrointest Endosc 50:329–333PubMedCrossRef

21.

Matsuda T, Fujii T, Saito Y, Nakajima T, Uraoka T, Kobayashi N, Ikehara H, Ikematsu H, Fu KI, Emura F, Ono A, Sano Y, Shimoda T, Fujimori T (2008) Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms. Am J Gastroenterol 103:2700–2706PubMedCrossRef

22.

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

23.

Hanaoka N, Uedo N, Ishihara R, Higashino K, Takeuchi Y, Inoue T, Chatani R, Hanafusa M, Tsujii Y, Kanzaki H, Kawada N, Iishi H, Tatsuta M, Tomita Y, Miyashiro I, Yano M (2010) Clinical features and outcomes of delayed perforation after endoscopic submucosal dissection for early gastric cancer. Endoscopy 42:1112–1115PubMedCrossRef

24.

Hamilton S, Aaltonen LA (eds) (2000) Pathology and genetics of tumours of the digestive system. Lyon, IARC, p 314

25.

Dixon MF (2002) Gastrointestinal epithelial neoplasia: Vienna revisited. Gut 51:130–131PubMedCrossRef

26.

Kim BC, Chang HJ, Han KS, Sohn DK, Hong CW, Park JW, Park SC, Choi HS, Oh JH (2011) Clinicopathological differences of laterally spreading tumors of the colorectum according to gross appearance. Endoscopy 43:100–107PubMedCrossRef

27.

Mukawa K, Fujii S, Takeda J, Kitajima K, Tominaga K, Chibana Y, Fujita M, Ichikawa K, Tomita S, Ono Y, Imura J, Kawamata H, Chiba T, Hiraishi H, Terano A, Fujimori T (2005) Analysis of K-ras mutations and expression of cyclooxygenase-2 and gastrin protein in laterally spreading tumors. J Gastroenterol Hepatol 20:1584–1590PubMedCrossRef

28.

Takahashi T, Nosho K, Yamamoto H, Mikami M, Taniguchi H, Miyamoto N, Adachi Y, Itoh F, Imai K, Shinomura Y (2007) Flat-type colorectal advanced adenomas (laterally spreading tumors) have different genetic and epigenetic alterations from protruded-type advanced adenomas. Mod Pathol 20:139–147PubMedCrossRef

29.

Noro A, Sugai T, Habano W, Nakamura S (2003) Analysis of Ki-ras and p53 gene mutations in laterally spreading tumors of the colorectum. Pathol Int 53:828–836PubMedCrossRef

30.

Hiraoka S, Kato J, Tatsukawa M, Harada K, Fujita H, Morikawa T, Shiraha H, Shiratori Y (2006) Laterally spreading type of colorectal adenoma exhibits a unique methylation phenotype and K-ras mutations. Gastroenterology 131:379–389PubMedCrossRef

31.

Hashimoto S, Higaki S, Amano A, Harada K, Nishikawa J, Yoshida T, Okita K, Sakaida I (2007) Relationship between molecular markers and endoscopic findings in laterally spreading tumors. J Gastroenterol Hepatol 22:30–36PubMedCrossRef

32.

Kim ES, Cho KB, Park KS, Lee KI, Jang BK, Chung WJ, Hwang JS (2011) Factors predictive of perforation during endoscopic submucosal dissection for the treatment of colorectal tumors. Endoscopy 43:573–578PubMedCrossRef

Title: Colorectal lateral spreading tumor subtypes: clinicopathology and outcome of endoscopic submucosal dissection
Authors: Mei-Dong Xu
Xiao-Yun Wang
Quan-Lin Li
Ping-Hong Zhou
Yi-Qun Zhang
Yun-Shi Zhong
Wei-Feng Chen
Li-Li Ma
Wen-Zheng Qin
Jian-Wei Hu
Li-Qing Yao
Publication date: 01-01-2013
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 1/2013
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-012-1543-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Colorectal lateral spreading tumor subtypes: clinicopathology and outcome of endoscopic submucosal dissection

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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