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Endoscopy-based decision is sufficient for predicting completeness in lateral resection margin in colon endoscopic
Ki Joo Kang1, Dong Uk Kim, Beom Jin Kim
1Department of Medicine, Sungkyunkwan University School of Medicine and Samsung Medical Center, Gangnam-gu, Seoul, Korea.
Digestion
|December 20, 2011
Summary
Discrepancies in colorectal tumor resection margins between pathologists and colonoscopists rarely lead to recurrence after endoscopic submucosal dissection (ESD). Surveillance colonoscopy may suffice, avoiding further ESD, when complete resection is endoscopically achieved despite positive lateral margins.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Pathology
Background:
- Investigating tumor recurrence after colorectal tumor resection.
- Focusing on discrepancies between pathological and endoscopic assessments of complete resection, particularly at the lateral margin.
Purpose of the Study:
- To determine the incidence of tumor recurrence when there is a diagnostic discrepancy in complete resection of colorectal tumors.
- To assess the significance of lateral resection margin status in these cases.
Main Methods:
- Retrospective review of 245 patients undergoing endoscopic submucosal dissection (ESD) for colorectal tumors (March 2006 - June 2011).
- Evaluation of recurrence rates in cases with pathologically incomplete resection despite endoscopic complete resection.
Main Results:
- Twenty-four cases had tumor cells on the lateral resection margin (19 tubular adenoma with low-grade dysplasia, 3 with high-grade dysplasia, 2 differentiated adenocarcinoma).
- No tumor recurrence was observed in 22 patients post-ESD; median follow-up was 19 months.
- Four patients did not undergo surveillance colonoscopy.
Conclusions:
- Surveillance colonoscopy may be a viable option for patients with pathologically incomplete lateral resection margins if endoscopic resection was grossly complete.
- This approach could potentially avoid additional endoscopic submucosal dissection (ESD).
- The retrospective analysis is limited by a short follow-up period.
