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Risk factors for residual cancer or lymph node metastasis after endoscopic noncurable resection of early colorectal cancerIntroduction:At present,endoscopic resection is one of the main operation methods for the treatment of early colorectal cancer.When the pathological results of mucosa indicate that there is non-cure resection and there is an indication for additional radical surgery,additional surgery is needed in time.However,in clinical practice,according to the existing guidelines,postoperative pathology of patients with additional radical surgery rarely see residual cancer or lymph node metastasis,which not only brings economic loss to patients,but also a secondary blow to patients,especially for patients with low rectal cancer,the impact of additional surgery on their later quality of life is obvious.At the same time,due to economic,physical and other comprehensive reasons,some patients are reluctant to add radical surgery,thus missing the best opportunity for treatment.However,due to the limitations of endoscopic surgery,it is difficult to evaluate the presence of residual cancer or lymph node metastasis according to the pathological characteristics of endoscopic specimens before additional radical surgery.Therefore,the significance of our study is to explore the risk factors related to residual cancer or lymph node metastasis in the lesions of additional radical surgery after endoscopic non-curative resection.In order to optimize the indications of additional radical surgery,avoid excessive additional radical surgery,and maximize the benefits of patients..Materials and Methods:The data of patients diagnosed with early colorectal cancer from 2009 to 2019 who underwent endoscopic treatment for early colorectal cancer in the Department of endoscopy,cancer hospital.Chinese Academy of Medical Sciences were collected.Among these cases,81 cases with non-curable resection after endoscopic resection were further screened out,who was added additional radical surgery in our hospital,to analyze the relationship between various factors and the risk of residual cancer or lymph node metastasis after endoscopic resection.Results:Patients with poorly differentiated carcinoma,depth of submucosal invasion?2000?m,positive vascular invasion venous invasion had a higher risk of cancer residual or lymph node metastasis after endoscopic non-curative resection,which was statistically significant.And lesions located in descending colon,transverse colon,ascending colon and cecum also had a higher risk of residual cancer or lymph node metastasis than those located in sigmoid colon and rectum,which was statistically significant.Logistic multivariate regression analysis showed that poorly differentiated cancer(OR=4.998.95%CI:1.046-23.873,P=0.044)was an independent risk factor for residual cancer or lymph node metastasis after endoscopic noncurative resection of early colorectal cancer.Conclusions:For early colorectal cancer after endoscopic non-curable resection,residual cancer or lymph node metastasis is more likely to occur when the postoperative mucosal pathology result is accompanied with poorly differentiated cancer,depth of submucosal invasion?2000?m,venous invasion and the lesions are located in the descending colon,transverse colon,ascending colon and cecum.Multivariate analysis showed that poorly differentiated cancer was an independent risk factor for residual cancer or lymph node metastasis after endoscopic non curable resection of early colorectal cancer.It was suggested that additional radical surgery should be performed for the lesions with poorly differentiated cancer.Part II Clinicopathological features of the colorectal serrated adenoma and analysis on influencing factors of malignancyIntroduction:As far as we know serrated adenoma is recognized as a precancerous lesion of colorectal cancer,and serrated pathway is considered to be an important pathway that can independently develop into colorectal cancer.About 30%of colorectal cancer is transformed from serrated pathway.It is of great significance to study the oncogenesis and development of colorectal cancer.we analyzed the distribution and potential malignant factors and summarized the clinical and pathological features of serrated adenoma in colorectum to provide some help for clinical practice in finding and identifing the precancerous lesion of serrated adenoma.Materials and Methods:A retrospective case-control study was conducted to collect the clinical data of patients with serrated adenoma who underwent colonoscopy and were pathologically diagnosed in the Cancer Hospital of Chinese Academy of Medical Sciences from April 2017 to July 2019,and exclude patients with two or more pathological types of lesions.The clinical characteristics of serrated adenoma were summarized,and univariate and logistic multivariate regression analysis was conducted to explore the influencing factors for serrated adenoma to develop malignant transformation.Results:Among 28 730 patients undergoing colonoscopy,311(1.08%)were found with 372 serrated adenomas,among which 22(5.9%)were sessile serrated adenomas/polyps.84(22.6%)were traditional serrated adenomas,and 266(71.5%)were unclassified serrated adenomas according to WHO classification.The pathological results showed that 106(28.5%)lesions were non-dysplasia,228(61.3%)lesions were low grade intraepithelial neoplasia,and 38(10.2%)lesions were high grade intraepithelial neoplasia or cancer.There were 204(54.8%)lesions with long-axis diameter<10mm and 168(45.2%)lesions with length long-axis? 10mm.238(64.0%)lesions were found in the left side colon and rectum and 134(36.0%)lesions in the right side colon.Gross classification under endoscopy:16 flat type lesions(4.3%),174 sessile lesions(46.8%),117 semi-pedunculated lesions(31.5%),59 pedunculated lesions(15.9%).Narrow-band imaging international colorectal endoscopic(NICE)classification:85(22.8%)type ? lesions,280(75.3%)type ? lesions,4(1.1%)type ? lesions.Univariate analysis showed that lesion size,lesion location,lesion site and different WHO classifications were associated with malignant transformation of colorectal serrated adenoma(all P<0.05).For the serrated adenomas with different NICE classifications,there were statistically significant differences in the distribution of malignant lesions among groups(P=0.001).Multivariate analysis showed that the long-axis diameter of the lesion?10mm(OR=6.699,95%CI:2.843-15.786)and the lesion locating in the left side colorectum(OR=2.657,95%CI:1.042-6.775)were independent risk factors for malignant transformationConclusions:Serrated adenomas mainly locate in the left side colon and rectum,and are prone to malignant transformation when the lesions are ?10mm in long-axis diameter or left-sided. |
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