Low value of second-look endoscopy for detecting residual colorectal cancer after endoscopic removal.,Gastrointestinal Endoscopy

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Low value of second-look endoscopy for detecting residual colorectal cancer after endoscopic removal.
Gastrointestinal Endoscopy ( IF 7.7 ) Pub Date : 2020-02-25 , DOI: 10.1016/j.gie.2020.01.056
Kim M Gijsbers ₁ , Zoë Post ₂ , Ruud W M Schrauwen ₃ , Thjon J Tang ₄ , Tanya M Bisseling ₅ , Dirk J Bac ₆ , Renzo P Veenstra ₇ , Ramon-Michel Schreuder ₈ , Ludger S M Epping Stippel ₉ , Wouter H de Vos Tot Nederveen Cappel ₁₀ , Rob M E Slangen ₁₁ , Niels van Lelyveld ₁₂ , Ellen M Witteman ₁₃ , Marc A W M van Milligen de Wit ₁₄ , Pieter Honkoop ₁₅ , Yasser Alderlieste ₁₆ , Pieter J C Ter Borg ₁₇ , Rolf van Roermund ₁₈ , Stephan Schmittgens ₁₉ , Evelien Dekker ₂₀ , Ivonne Leeuwenburgh ₂₁ , Rogier J J de Ridder ₂₂ , Anke M Zonneveld ₂₃ , Muhammed Hadithi ₂₄ , Monique E van Leerdam ₂₅ , Marco J Bruno ₂₆ , Frank P Vleggaar ₂₇ , Leon M G Moons ₂₇ , Arjun D Koch ₂₆ , Frank Ter Borg ₁

Affiliation

Department of Gastroenterology and Hepatology, Deventer Ziekenhuis, Deventer, the Netherlands.
Department of Gastroenterology and Hepatology, Deventer Ziekenhuis, Deventer, the Netherlands; Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA.
Department of Gastroenterology and Hepatology, Ziekenhuis Bernhoven, Uden, the Netherlands.
Department of Gastroenterology and Hepatology, Ijsselland Ziekenhuis, Capelle aan de Ijssel, the Netherlands.
Department of Gastroenterology and Hepatology, RadboudUMC, Nijmegen, the Netherlands.
Department of Gastroenterology and Hepatology, Ziekenhuis Gelderse Vallei, Ede, the Netherlands.
Department of Gastroenterology and Hepatology, Martini Ziekenhuis, Groningen, the Netherlands.
Department of Gastroenterology and Hepatology, Catharina Ziekenhuis, Eindhoven, the Netherlands.
Department of Gastroenterology and Hepatology, Maasziekenhuis Pantein, Boxmeer, the Netherlands.
Department of Gastroenterology and Hepatology, Isala Klinieken, Zwolle, the Netherlands.
Department of Gastroenterology and Hepatology, HAGA Ziekenhuis, Den Haag, the Netherlands.
Department of Gastroenterology and Hepatology, St. Antonius Ziekenhuis, Nieuwegein, the Netherlands.
Department of Gastroenterology and Hepatology, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands.
Department of Gastroenterology and Hepatology, Amphia Ziekenhuis, Breda, the Netherlands.
Department of Gastroenterology and Hepatology, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands.
Department of Gastroenterology and Hepatology, Rivas Zorggroep, Gorinchem, the Netherlands.
Department of Gastroenterology and Hepatology, Ikazia Ziekenhuis, Rotterdam, the Netherlands.
Department of Gastroenterology and Hepatology, Ziekenhuis Groep Twente, Almelo, the Netherlands.
Department of Gastroenterology and Hepatology, Ziekenhuis Nij Smellinghe, Drachten, the Netherlands.
Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, the Netherlands.
Department of Gastroenterology and Hepatology, Franciscus, location Gasthuis and Vlietland, Rotterdam, the Netherlands.
Department of Gastroenterology and Hepatology, Maastricht UMC+, Maastricht, the Netherlands.
Department of Gastroenterology and Hepatology, Ziekenhuis Nij Smellinghe, Drachten, the Netherlands; Department of Gastroenterology and Hepatology, Antonius Ziekenhuis Sneek-Emmeloord, Sneek, the Netherlands.
Department of Gastroenterology and Hepatology, Maasstad Ziekenhuis, Rotterdam, the Netherlands.
Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
Department of Gastroenterology and Hepatology, Utrecht Medical University Center, Utrecht, the Netherlands.

Background and Aims

Endoscopic resection is often feasible for submucosal invasive colorectal cancers (T1 CRCs) and usually judged as complete. If histology casts doubt on the radicality of resection margins, adjuvant surgical resection is advised, although residual intramural cancer is found in only 5% to 15% of patients. We assessed the sensitivity of biopsy specimens from the resection area for residual intramural cancer as a potential tool to estimate the preoperative risk of residual intramural cancer in patients without risk factors for lymph node metastasis (LNM).

Methods

In this multicenter prospective cohort study, patients with complete endoscopic resection of T1 CRC, scheduled for adjuvant resection due to pathologically unclear resection margins, but absent risk factors for LNM, were asked to consent to second-look endoscopy with biopsies. The results were compared with the pathology results of the surgical resection specimen (criterion standard).

Results

One hundred three patients were included. In total, 85% of resected lesions were unexpectedly malignant, and 45% were removed using a piecemeal resection technique. Sixty-four adjuvant surgical resections and 39 local full-thickness resections were performed. Residual intramural cancer was found in 7 patients (6.8%). Two of these patients had cancer in second-look biopsy specimens, resulting in a sensitivity of 28% (95% confidence interval, <58%). The preoperative risk of residual intramural cancer in the case of negative biopsy specimens was not significantly reduced (P = .61).

Conclusions

The sensitivity of second-look endoscopy with biopsies for residual intramural cancer after endoscopic resection of CRC is low. Therefore, it should not be used in the decision whether or not to perform adjuvant resection. (Clinical trial registration number: NCT02328664.)

中文翻译：

内窥镜摘除后用于检查残留结直肠癌的第二眼内窥镜检查的价值低。

背景和目标

内镜切除术对于粘膜下浸润性结直肠癌（T1 CRC）通常是可行的，并且通常被判断为完全切除。如果组织学对切除切缘的根本性产生怀疑，建议进行辅助手术切除，尽管仅5％至15％的患者发现残留的壁内癌。我们评估了切除区域的活检标本对残留壁内癌的敏感性，作为评估没有淋巴结转移（LNM）危险因素的患者残留壁内癌的术前风险的潜在工具。

方法

在这项多中心前瞻性队列研究中，由于病理学上不清楚的切除切缘，计划进行辅助切除的T1 CRC完整内镜切除术患者，但缺少LNM的危险因素，被要求同意接受第二次内窥镜活检。将结果与手术切除标本的病理结果（标准）进行比较。

结果

包括一百零三名患者。总体而言，切除的病变中有85％出乎意料地是恶性的，并且采用逐段切除技术切除了45％。进行了64例辅助手术切除和39例局部全层切除。残壁内癌发现7例（6.8％）。这些患者中有两名在第二次活检标本中患有癌症，敏感性为28％（95％置信区间，<58％）。在活检标本阴性的情况下，术前残留壁内癌的风险没有显着降低（P = .61）。