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⁎4506 Clinicopathologic characteristics of lateral spreading tumors in colorectum.
*4506 CLINICOPATHOLOGIC CHARACTERISTICS OF LATERAL SPREADING TUMORS IN COLORECTUM. Moon Sung Lee, Sang Kyoon Kim, Jin Oh Kim, Joo Young Cho, Yun Soo Kim, Joon Seong Lee, Chan Sup Shim, Institute for Digest Research, Soon Chun Hyang Univ, Seoul, South Korea. Background/Aims: Among colorectal neoplasms, laterally spreading tumors(LSTs) are defined as tumors over 10mm in diameter that are low in height and grow superficially. We performed this study to analyze the clinicopathologic characteristics of LSTs in colorectum. Materials/Methods : Forty six LSTs diagnosed by colonoscopy were analyzed according to their endoscopic and pathologic findings. The lesions were macroscopically classified into two categories according to their surface structure; granular type(G type), nongranular type(F type). Granular types were subdivided into granular-homogeneous type(GH type) and mixed-nodular type(MN type). Results : 1) Incidence of LSTs were 46(2.0%) among the total 2276 colorectal adenomas. 2) Out of 46 LSTs, 22 (47.8%) were less than 20mm in diameter, 20 (43.5%) were 20-30mm in diameter, 4 (8.7%) were larger than 30mm in diameter. 2) The most frequent location was the rectosigmoid colon(54.3%, 25/46), followed by the ascending colon(21.7%, 10/46). 4) GH types were 37.0%(17/46), MN types were 30.4%(14/46), F types were 32.6%(15/46). 5) Histopathologically, adenoma components were tubular types in 65.2%(30/46), tubulovillous types in 26.1%(12/46), villous types in 8.7%(4/46). 6) High grade dysplasia, mucosal carcinoma and submucosal carcinoma were present in 19.6%(9/46), 13.0%(6/46), 6.5%(3/46), respectively. The overall malignancy rate was 19.6%(9/46). 7) Malignancy rates according to their sizes were 9.1%(1/22) in the lesions less than 20mm in diameter, 30.0%(6/20) in the lesions with 20-30mm in diameter, 50.0%(2/4) in the lesions larger than 30mm in diameter. 8) Malignancy rates according to their morphologic types were 11.8%(2/17) in GH type, 21.4%(3/14) in NM type and 26.7%(4/15) in F type. Carcinoma invaded into the submucosa were present in one lesion of MN types and two of F type. Conclusions : LSTs larger than 20mm in diameter had high malgnant potential, which was more than 30%. Furthermore, LSTs showed different clinicopathologic characteristics depending on the morphologic classification. MN or F type LSTs had higher malignant potential than GH type. *4507 ENDOSCOPIC ULTRASOUND ACCURATELY STAGES AND DIRECTS THE SURGICAL MANAGEMENT OF RECTAL CARCINOMA. Won Sohn, Michael Lieberman, Mark Pochapin, WEILL Med Coll OF CORNELL Univ, New York, NY. Background: Endoscopic Ultrasound (EUS) has become one of the best methods for staging gastrointestinal cancers. The preoperative local staging of rectal cancer is important since new transanal surgical techniques can preserve rectal and anal function. The purpose of this study is to assess the accuracy of EUS staging and evaluate the impact of EUS on the surgical management of rectal cancer. Method: A retrospective chart and database review of 23 patients with rectal cancer who underwent rectal EUS at Cornell Weill Medical College from 1997 to 1999 was performed. The medical history, EUS staging, surgical pathology, radiographic studies, and treatment were reviewed. Result: 17 patients had surgical pathology available from 23 patients. Using surgical pathology as the benchmark, accuracy of EUS staging was assessed. T stage accuracy was 94 % (16/17), and N stage accuracy was 100 % (17/17). Fine Needle Aspiration (FNA) was performed on 4 patients and yielded the correct diagnosis with 100% accuracy (4/4). In 6 patients with EUS stage T3N0 or greater (4 patients with EUS stage T3N0 and 2 patients with EUS stage T3N1), 2 patients underwent low anterior resection (LAR) and 3 patients underwent abdominal peritoneal resection (APR). 1 patient underwent transanal resection (TAR) because he was poor surgical candidate. In 11 patients with EUS stage T2 N0 or less (7 patients with EUS stage T2N0 and 4 patients with EUS stage T1N0), 2 patients had endoscopic removal, 5 patients underwent TAR and 4 patients had LAR. 10 of the 11 patients were accurately staged and 1 patient was overstaged as T2 by EUS. No patients were understaged. EUS directed surgical management in 85 % (12/14) of patients with rectal cancer. For these patients, T3 or N1 EUS staging resulted in LAR and EUS T2, T1, and N0 determinations resulted in TAR. Conclusion: EUS can accurately stage rectal cancer and direct the choice of surgical approach. Further study is needed to draw more definitive conclusions. *4508 SCREENING FLEXIBLE SIGMOIDOSCOPY BEYOND THE AGE OF SEVENTY: WHEN TO STOP? Brendan H. Levy, Masud Shaukat, Francisco C. Ramirez, Carl T Hayden VA Med Ctr, Phoenix, AZ. Currently there are no national guidelines addressing at what age screening for colon cancer should be stopped. As the population grows older the
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theory of competing risks takes place and screening procedures may become unnecessary. AIM: To assess the impact of flexible sigmoidoscopy in patients who are older than 70 years of age. MATERIAL AND METHODS: All flexible sigmoidoscopies performed at a single institution between February 1993 and February 1995 were reviewed. Those patients whose age was 70 or older were studied and further divided into 3 groups: 70-74 years (Group A), 75-79 years (Group B) and older than 80 years (Group C). The prevalence of adenomas or carcinoma found as a result of the flexible sigmoidoscopy and overall 5-year mortality were determined. RESULTS: A total of 1271 flexible sigmoidoscopies were performed during the study period. Of these, 369 (29%) corresponded to patients 70 years of age or older. Of this group, there were 245 patients in Group A (66.4%), 101 in Group B (27.4%) and 23 in Group C (6.2%). The rate of adenomas found in the entire group of elderly patients was 16.3% (60/369). The probability of finding adenomas progressively decreased from Group A to Group C (p=0.09). The probability of finding carcinoma was not statistically different amongst the 3 groups. Of the 3 cancers in Group B, only one was detected as a result of screening flexible sigmoidoscopy, the other 2 had symptoms that prompted the study. The 5-year mortality from any cause was significantly higher in Groups B and C when compared to Group A (Table). CONCLUSIONS: 1) Screening flexible sigmoidoscopy remains an invaluable tool for colon cancer screening purposes but may not be indicated at age 80 or older given the low yield and the high 5-year mortality. 2) Based on our findings, age 75 may be a reasonable cutoff for screening flexible sigmoidoscopy.
Adenomas Carcinomas 5-y Mortality
Group A
Group B
46/245 (18.8%) 4/245 (1.6%) 44/245 (18%)ab
13/101 (12.9%) 3/101 (3%) 35/101 (34.6%)a
Group C 1/23 (4.3%) 0/23 (0%) 12/23 (52.2%)b
a: 5-y mortality. Group A vs Group B (p=0.001; OR: 0.4; CI: 0.23, 0.72); b: 5-y mortality. Group A vs Group C (p=0.0004; OR: 0.2; CI: 0.07, 0.5) *4509 LASER THERAPY OF COLORECTAL CANCER:IS THERE A ROLE FOR PHOTODYNAMIC THERAPY? Alan A. Weiss, Yu K. Kim, British Columbia Cancer Agency-VCC, Vancouver, BC, Canada. Laser therapy of colorectal cancer (CRC) may be used to maintain a luminal patency and to relieve local complications of bleeding and mucus discharge. The effectiveness of potassium titanyl phosphate (KTP)laser therapy in controlling the symptoms of 1) obstruction due to CRC and 2)frequent mucus and blood discharge due to recurrence of cancer in a rectal stump post Hartmann’s procedure was evaluated. Results: 1) Ten patients with CRC obstructing the lumen were treated with a KTP laser which was set to 15 mW to ablate the tumour tissue. In nine patients the treatment was successful with the resolution of abdominal symptoms and the maintenance of bowel movements. The number of treatments varied from 1-6, (mean of 3)and were administered approximately 1-2 months apart. In one patient, who was not treated for 3 months, the lumen became completely obstucted and so precluded laser therapy. The treatments were well tolerated; no complications occurred and patients were well palliated. 2) Twelve patients with a severe and disabling urgency and a frequency of blood and mucus discharge due to recurrence of cancer within the rectal stump were treated with KTP laser set to coagulation settings of 5 mW. Patients required 1-6 treatments (mean of 2)which were performed 1-3 months apart. In six patients a very significant improvement of symptoms was achieved; in the other six there was minimal or no improvement. There were no laser-related complications in this group. The success of the treatment was related to the ability to use the laser in an “en face” position in order to coagulate a significant surface area of the cancer. In one patient who had an extensive tumor within the rectal stump and who did not respond to laser treatment, Photodynamic therapy (PDT) was performed, using porfimer sodium as a sensitizer. The laser light at 630 nm was delivered via a 5 cm long fibre optic cylindrical diffuser. This patient experienced an excellent response with a resolution of a previously very symptomatic discharge. The response was rapid in onset and of long duration (6+ months follow-up). KTP laser treatment is a useful alternative to diverting colostomy and stent insertion in patients with a partially obstructive CRC; it may provide a worthwhile and safe palliation in patients who present with a recurrence of cancer within a rectal pouch. In patients where adequate laser therapy is not possible, PDT may represent a new and successful therapeutic approach. Therefore,further trials of PDT in the palliation of colorectal cancer are indicated.
VOLUME 51, NO. 4, PART 2, 2000
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theory of competing risks takes place and screening procedures may become unnecessary. AIM: To assess the impact of flexible sigmoidoscopy in patients who are older than 70 years of age. MATERIAL AND METHODS: All flexible sigmoidoscopies performed at a single institution between February 1993 and February 1995 were reviewed. Those patients whose age was 70 or older were studied and further divided into 3 groups: 70-74 years (Group A), 75-79 years (Group B) and older than 80 years (Group C). The prevalence of adenomas or carcinoma found as a result of the flexible sigmoidoscopy and overall 5-year mortality were determined. RESULTS: A total of 1271 flexible sigmoidoscopies were performed during the study period. Of these, 369 (29%) corresponded to patients 70 years of age or older. Of this group, there were 245 patients in Group A (66.4%), 101 in Group B (27.4%) and 23 in Group C (6.2%). The rate of adenomas found in the entire group of elderly patients was 16.3% (60/369). The probability of finding adenomas progressively decreased from Group A to Group C (p=0.09). The probability of finding carcinoma was not statistically different amongst the 3 groups. Of the 3 cancers in Group B, only one was detected as a result of screening flexible sigmoidoscopy, the other 2 had symptoms that prompted the study. The 5-year mortality from any cause was significantly higher in Groups B and C when compared to Group A (Table). CONCLUSIONS: 1) Screening flexible sigmoidoscopy remains an invaluable tool for colon cancer screening purposes but may not be indicated at age 80 or older given the low yield and the high 5-year mortality. 2) Based on our findings, age 75 may be a reasonable cutoff for screening flexible sigmoidoscopy.
Adenomas Carcinomas 5-y Mortality
Group A
Group B
46/245 (18.8%) 4/245 (1.6%) 44/245 (18%)ab
13/101 (12.9%) 3/101 (3%) 35/101 (34.6%)a
Group C 1/23 (4.3%) 0/23 (0%) 12/23 (52.2%)b
a: 5-y mortality. Group A vs Group B (p=0.001; OR: 0.4; CI: 0.23, 0.72); b: 5-y mortality. Group A vs Group C (p=0.0004; OR: 0.2; CI: 0.07, 0.5) *4509 LASER THERAPY OF COLORECTAL CANCER:IS THERE A ROLE FOR PHOTODYNAMIC THERAPY? Alan A. Weiss, Yu K. Kim, British Columbia Cancer Agency-VCC, Vancouver, BC, Canada. Laser therapy of colorectal cancer (CRC) may be used to maintain a luminal patency and to relieve local complications of bleeding and mucus discharge. The effectiveness of potassium titanyl phosphate (KTP)laser therapy in controlling the symptoms of 1) obstruction due to CRC and 2)frequent mucus and blood discharge due to recurrence of cancer in a rectal stump post Hartmann’s procedure was evaluated. Results: 1) Ten patients with CRC obstructing the lumen were treated with a KTP laser which was set to 15 mW to ablate the tumour tissue. In nine patients the treatment was successful with the resolution of abdominal symptoms and the maintenance of bowel movements. The number of treatments varied from 1-6, (mean of 3)and were administered approximately 1-2 months apart. In one patient, who was not treated for 3 months, the lumen became completely obstucted and so precluded laser therapy. The treatments were well tolerated; no complications occurred and patients were well palliated. 2) Twelve patients with a severe and disabling urgency and a frequency of blood and mucus discharge due to recurrence of cancer within the rectal stump were treated with KTP laser set to coagulation settings of 5 mW. Patients required 1-6 treatments (mean of 2)which were performed 1-3 months apart. In six patients a very significant improvement of symptoms was achieved; in the other six there was minimal or no improvement. There were no laser-related complications in this group. The success of the treatment was related to the ability to use the laser in an “en face” position in order to coagulate a significant surface area of the cancer. In one patient who had an extensive tumor within the rectal stump and who did not respond to laser treatment, Photodynamic therapy (PDT) was performed, using porfimer sodium as a sensitizer. The laser light at 630 nm was delivered via a 5 cm long fibre optic cylindrical diffuser. This patient experienced an excellent response with a resolution of a previously very symptomatic discharge. The response was rapid in onset and of long duration (6+ months follow-up). KTP laser treatment is a useful alternative to diverting colostomy and stent insertion in patients with a partially obstructive CRC; it may provide a worthwhile and safe palliation in patients who present with a recurrence of cancer within a rectal pouch. In patients where adequate laser therapy is not possible, PDT may represent a new and successful therapeutic approach. Therefore,further trials of PDT in the palliation of colorectal cancer are indicated.
VOLUME 51, NO. 4, PART 2, 2000