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Distribution of Synchronous Neoplasms Detected at Colorectal Cancer Resection
Abstracts
W1116 Predictors of Isolated Advanced Proximal Neoplasia of Colon: The Kasid Prospective Multicenter Study Hyun Soo Kim, Won Ho Kim, Tae Il Kim, Young-Ho Kim, Hyo Jong Kim, Suk-Kyun Yang, Seung-Jae Myung, Jeong-Sik Byeon, Moon Sung Lee, Il Kwon Jung, Sung-Ae Jung, Moon Kwan Chung, Yoon Tae Jeen, Jai Hyun Choi, Hwang Choi, Dong Soo Han, Jae Suk Song Background: Although advanced adenomatous polyp is an ideal target of colorectal cancer screening, isolated proximal neoplasia without distal pathology would have been missed on a flexible sigmoidoscopy, an effective colorectal cancer screening technique. The aim of the study is to identify predictors of isolated advanced proximal neoplasia of colon. Methods: Data were prospectively collected from the 17,200 patients who presented for colonoscopy in 12 tertiary endoscopic centers. Information gathered included demographic characteristics including body mass index (BMI), endoscopic findings, histology, drug history of aspirin/ NSAID, and known risk factors for colorectal neoplasia. We compared the patients with isolated proximal advanced neoplasia with the patients without colon neoplasia. We defined advanced neoplasia as adenocarcinoma, high-grade dysplasia, villous polyps, or adenomas more than 11 mm. Results: Isolated advanced proximal neoplasia was found in 371 (2.2%) patients, and 6234 (36.2%) patients as a control group had no colon neoplasia. While patients older than 65 year had a risk for isolated advanced proximal neoplasia (OR Z 1.38: 95% CI Z 1.07-1.78; p Z 0.015), male gender, obesity (BMI; O27), those who took a daily aspirin or NSAID, and a family history of colorectal cancer were not associated with an increased risk of isolated advanced proximal neoplasia. Conclusion: Because age greater than 65 year increased the risk of finding isolated proximal advanced neoplasia, colonoscopy rather than flexible sigmoidoscopy should be the first consideration as a colorectal screening in the older population.
W1117 Endoscopic Mucosal Resection of Early Colon Cancer: Additional Therapy and Clinical Outcomes Sang Gyune Kim, Sung Won Jung, Bong Min Ko, Su Jin Hong, Chang Beom Ryu, Young Seok Kim, Joo Young Cho, Kye Won Kwon, Moon Sung Lee, Chan Sup Shim, Boo Sung Kim Background/Aims: With the recent development of endoscopic equipment, the rate to find out early colon cancer and to treat it endoscopically has been increased. A number of remnant or recurrent tumors after endoscopic resection were managed successfully through salvage endoscopic mucosal resection (EMR) or argon plasma coagulation (APC). This study evaluated the outcomes of EMR for early colon cancer and efficacy of additional therapy to prevent tumor recurrence. Methods: During the period from March 2001 to April 2004, a total of 50 early colon cancers were resected endoscopically and analyzed retrospectively. EMR was performed either piecemeal method or en bloc method by conventional EMR with snare and cap aspiration and by submucosal dissection. The patients were followed up at 3, 6, 12, 24 months and median follow up period was 21.8 months. By using the magnifying endoscopy, if the endoscopists judged the tumor incompletely excised or recurred, APC and EMR as additional therapy were done. Results: Total 50 early colon cancers comprised 44 mucosal cancers and 6 submucosal cancers in which en bloc resection was 34 (68%) and piecemeal resection was 16 (32%). Apart from the 13 cases which were unable to ensure its lateral margin free because of piecemeal resection, complete resection rate was 26/37 (70.3%). The 20 cases receiving additional therapy consisted of 8 cases of en bloc resection and 12 cases of piecemeal resection. Recurrence rate of previous additional therapy was 1/20 (5%). Conclusions: For endoscopic treatment of early colon cancer en bloc resection is much better than piecemeal resection because of its high complete resection rate. But, in case of suggestive incomplete resection, recurrence rate would be decreased through the additional therapy. The long term results of additional therapy after EMR for Early colon cancer seem to be required for more study. Early colon cancer, Endoscopic mucosal resection, Additional therapy
AB256 GASTROINTESTINAL ENDOSCOPY Volume 61, No. 5 : 2005
W1118 Colonoscopic Findings of the Distal Colorectum in Patients with Proximal Adenomas and Cancers Seiji Kimura, Masanori Tanaka Background and Aims: Full colonoscopy is necessary to detect high-risk lesion and curable cancer in the proximal colon, while it has been suggested that patients without distal neoplasm do not require proximal examination. The present study aimed to analyze the conditions of the distal colon in patients with proximal neoplasm and to discuss the necessity of a full colonoscopy in the absence of distal neoplasms. Methods: A total of 3827 patients underwent a full colonoscopy during past 10 years in our hospital, and 413 patients (Mean age: 66.9Cÿ10.1, M:F Z 257:156) were found to have adenoma or carcinoma in the proximal colon. Proximal colon meaned the cecum to the descending colon in this study. Colonoscopic findings of the distal colorectum in patients with proximal low-grade lesions (LGLs) were compared to those in patients with proximal high-grade lesions (HGLs); HGLs were defined as adenoma larger than 10 mm in diameter, villous adenoma, adenoma with high-grade dysplasia or cancer. Results: Out of the above 413 patients with proximal neoplasms, LGLs were found in 272 patients (Mean age: 65.5Cÿ10.4, M:F Z 175:97) and HGLs in 141 patients (Mean age: 69.7Cÿ9.1, M:F Z 82:59), respectively. There was no difference in gender distribution between two groups, but the age was more advanced in the latter group (p ! 0.001). The prevalence of proximal LGLs and HGLs in overall patients were 7.1% (272/3827), and 3.7% (141/3827), respectively. Among 272 patients with proximal LGLs and 141 patients with proximal HGLs, 170 (62.5%) and 85 (60.3%) had normal distal colorectum, 68 (25.0%) and 29 (20.6%) were associated with distal LGLs, and 34 (12.5%) and 27 (19.2%) were associated with distal HGLs, respectively. Patients with proximal HGLs were more likely to have distal HGLs when compared to those with proximal LGLs, but it did not reach statistical significance (p Z 0.073). Over 60% of both patients with proximal LGLs (170/272) and those with proximal HGLs (85/141) revealed to have normal distal colorectum with no statistical difference between them. Conclusion: A high percentage of patients with proximal HGLs showed normal distal colorectum, as well as those with proximal LGLs. The use of colonoscopy to examine proximal sites of the colon might be reasonable even in the absence of distal neoplasm.
W1119 Distribution of Synchronous Neoplasms Detected at Colorectal Cancer Resection Seiji Kimura, Masanori Tanaka Background and Aims: Multiple colorectal adenomas and cancers are frequently found at colonoscopy when colonoscopic or surgical resection of colorectal cancers are carried out. However, the relationship between the distributions of the primary cancers and those of the synchronous neoplasms has not fully been understood. The present study aimed to evaluate the frequency of synchronous neoplasms in the proximal and distal colon. Methods: The study included 397 patients with colonoscopically or surgically resected colorectal cancer during past 10 years in our hospital (215 intramucosal, and 182 invasive cancers). Synchronous colorectal neoplasms (adenoma or cancer) were found by resectional colonoscopy or colonoscopy performed just before and after surgery. Using the sigmoiddescending colon junction as a landmark indicating the proximal and distal colon, the distributions of synchronous colorectal neoplasms detected with primary cancers were statistically analyzed. Results: Among 397 primary colorectal cancers 130 (32.7%) were located in the proximal colon, and 267 (67.3%) in the distal colon. Among 130 proximal cancers 54 (41.5%) were isolated, 33 (25.4%) were detected with synchronous proximal neoplasm only, 21 (16.2%) with synchronous distal neoplasm only, and 22 (16.9%) with synchronous both proximal and distal neoplasms. Among 267 distal cancers 127 (47.6%) were isolated, 30 (11.2%) were detected with synchronous proximal neoplasm only, 85 (31.8%) with synchronous distal neoplasm only, and 25 (9.4%) with synchronous both proximal and distal neoplasms. More than a half of the primary colorectal cancers (58.5% of proximal, and 52.4% of distal cancers) were associated with synchronous neoplasms. Proximal cancers were found significantly more often with synchronous proximal neoplasms, while distal cancers were more often with synchronous distal neoplasms (p ! 0.005). Majority of proximal, and distal cancers (66.9% and 79.4%) were detected without synchronous distal, and synchronous proximal neoplasms, respectively. Conclusion: A close relationship between the distributions of primary colorectal cancers and those of synchronous neoplasms was demonstrated. Careful attention should be paid more to the adjacent side compared with the distant side of the colon to find synchronous neoplasms at colorectal cancer resection.
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W1116 Predictors of Isolated Advanced Proximal Neoplasia of Colon: The Kasid Prospective Multicenter Study Hyun Soo Kim, Won Ho Kim, Tae Il Kim, Young-Ho Kim, Hyo Jong Kim, Suk-Kyun Yang, Seung-Jae Myung, Jeong-Sik Byeon, Moon Sung Lee, Il Kwon Jung, Sung-Ae Jung, Moon Kwan Chung, Yoon Tae Jeen, Jai Hyun Choi, Hwang Choi, Dong Soo Han, Jae Suk Song Background: Although advanced adenomatous polyp is an ideal target of colorectal cancer screening, isolated proximal neoplasia without distal pathology would have been missed on a flexible sigmoidoscopy, an effective colorectal cancer screening technique. The aim of the study is to identify predictors of isolated advanced proximal neoplasia of colon. Methods: Data were prospectively collected from the 17,200 patients who presented for colonoscopy in 12 tertiary endoscopic centers. Information gathered included demographic characteristics including body mass index (BMI), endoscopic findings, histology, drug history of aspirin/ NSAID, and known risk factors for colorectal neoplasia. We compared the patients with isolated proximal advanced neoplasia with the patients without colon neoplasia. We defined advanced neoplasia as adenocarcinoma, high-grade dysplasia, villous polyps, or adenomas more than 11 mm. Results: Isolated advanced proximal neoplasia was found in 371 (2.2%) patients, and 6234 (36.2%) patients as a control group had no colon neoplasia. While patients older than 65 year had a risk for isolated advanced proximal neoplasia (OR Z 1.38: 95% CI Z 1.07-1.78; p Z 0.015), male gender, obesity (BMI; O27), those who took a daily aspirin or NSAID, and a family history of colorectal cancer were not associated with an increased risk of isolated advanced proximal neoplasia. Conclusion: Because age greater than 65 year increased the risk of finding isolated proximal advanced neoplasia, colonoscopy rather than flexible sigmoidoscopy should be the first consideration as a colorectal screening in the older population.
W1117 Endoscopic Mucosal Resection of Early Colon Cancer: Additional Therapy and Clinical Outcomes Sang Gyune Kim, Sung Won Jung, Bong Min Ko, Su Jin Hong, Chang Beom Ryu, Young Seok Kim, Joo Young Cho, Kye Won Kwon, Moon Sung Lee, Chan Sup Shim, Boo Sung Kim Background/Aims: With the recent development of endoscopic equipment, the rate to find out early colon cancer and to treat it endoscopically has been increased. A number of remnant or recurrent tumors after endoscopic resection were managed successfully through salvage endoscopic mucosal resection (EMR) or argon plasma coagulation (APC). This study evaluated the outcomes of EMR for early colon cancer and efficacy of additional therapy to prevent tumor recurrence. Methods: During the period from March 2001 to April 2004, a total of 50 early colon cancers were resected endoscopically and analyzed retrospectively. EMR was performed either piecemeal method or en bloc method by conventional EMR with snare and cap aspiration and by submucosal dissection. The patients were followed up at 3, 6, 12, 24 months and median follow up period was 21.8 months. By using the magnifying endoscopy, if the endoscopists judged the tumor incompletely excised or recurred, APC and EMR as additional therapy were done. Results: Total 50 early colon cancers comprised 44 mucosal cancers and 6 submucosal cancers in which en bloc resection was 34 (68%) and piecemeal resection was 16 (32%). Apart from the 13 cases which were unable to ensure its lateral margin free because of piecemeal resection, complete resection rate was 26/37 (70.3%). The 20 cases receiving additional therapy consisted of 8 cases of en bloc resection and 12 cases of piecemeal resection. Recurrence rate of previous additional therapy was 1/20 (5%). Conclusions: For endoscopic treatment of early colon cancer en bloc resection is much better than piecemeal resection because of its high complete resection rate. But, in case of suggestive incomplete resection, recurrence rate would be decreased through the additional therapy. The long term results of additional therapy after EMR for Early colon cancer seem to be required for more study. Early colon cancer, Endoscopic mucosal resection, Additional therapy
AB256 GASTROINTESTINAL ENDOSCOPY Volume 61, No. 5 : 2005
W1118 Colonoscopic Findings of the Distal Colorectum in Patients with Proximal Adenomas and Cancers Seiji Kimura, Masanori Tanaka Background and Aims: Full colonoscopy is necessary to detect high-risk lesion and curable cancer in the proximal colon, while it has been suggested that patients without distal neoplasm do not require proximal examination. The present study aimed to analyze the conditions of the distal colon in patients with proximal neoplasm and to discuss the necessity of a full colonoscopy in the absence of distal neoplasms. Methods: A total of 3827 patients underwent a full colonoscopy during past 10 years in our hospital, and 413 patients (Mean age: 66.9Cÿ10.1, M:F Z 257:156) were found to have adenoma or carcinoma in the proximal colon. Proximal colon meaned the cecum to the descending colon in this study. Colonoscopic findings of the distal colorectum in patients with proximal low-grade lesions (LGLs) were compared to those in patients with proximal high-grade lesions (HGLs); HGLs were defined as adenoma larger than 10 mm in diameter, villous adenoma, adenoma with high-grade dysplasia or cancer. Results: Out of the above 413 patients with proximal neoplasms, LGLs were found in 272 patients (Mean age: 65.5Cÿ10.4, M:F Z 175:97) and HGLs in 141 patients (Mean age: 69.7Cÿ9.1, M:F Z 82:59), respectively. There was no difference in gender distribution between two groups, but the age was more advanced in the latter group (p ! 0.001). The prevalence of proximal LGLs and HGLs in overall patients were 7.1% (272/3827), and 3.7% (141/3827), respectively. Among 272 patients with proximal LGLs and 141 patients with proximal HGLs, 170 (62.5%) and 85 (60.3%) had normal distal colorectum, 68 (25.0%) and 29 (20.6%) were associated with distal LGLs, and 34 (12.5%) and 27 (19.2%) were associated with distal HGLs, respectively. Patients with proximal HGLs were more likely to have distal HGLs when compared to those with proximal LGLs, but it did not reach statistical significance (p Z 0.073). Over 60% of both patients with proximal LGLs (170/272) and those with proximal HGLs (85/141) revealed to have normal distal colorectum with no statistical difference between them. Conclusion: A high percentage of patients with proximal HGLs showed normal distal colorectum, as well as those with proximal LGLs. The use of colonoscopy to examine proximal sites of the colon might be reasonable even in the absence of distal neoplasm.
W1119 Distribution of Synchronous Neoplasms Detected at Colorectal Cancer Resection Seiji Kimura, Masanori Tanaka Background and Aims: Multiple colorectal adenomas and cancers are frequently found at colonoscopy when colonoscopic or surgical resection of colorectal cancers are carried out. However, the relationship between the distributions of the primary cancers and those of the synchronous neoplasms has not fully been understood. The present study aimed to evaluate the frequency of synchronous neoplasms in the proximal and distal colon. Methods: The study included 397 patients with colonoscopically or surgically resected colorectal cancer during past 10 years in our hospital (215 intramucosal, and 182 invasive cancers). Synchronous colorectal neoplasms (adenoma or cancer) were found by resectional colonoscopy or colonoscopy performed just before and after surgery. Using the sigmoiddescending colon junction as a landmark indicating the proximal and distal colon, the distributions of synchronous colorectal neoplasms detected with primary cancers were statistically analyzed. Results: Among 397 primary colorectal cancers 130 (32.7%) were located in the proximal colon, and 267 (67.3%) in the distal colon. Among 130 proximal cancers 54 (41.5%) were isolated, 33 (25.4%) were detected with synchronous proximal neoplasm only, 21 (16.2%) with synchronous distal neoplasm only, and 22 (16.9%) with synchronous both proximal and distal neoplasms. Among 267 distal cancers 127 (47.6%) were isolated, 30 (11.2%) were detected with synchronous proximal neoplasm only, 85 (31.8%) with synchronous distal neoplasm only, and 25 (9.4%) with synchronous both proximal and distal neoplasms. More than a half of the primary colorectal cancers (58.5% of proximal, and 52.4% of distal cancers) were associated with synchronous neoplasms. Proximal cancers were found significantly more often with synchronous proximal neoplasms, while distal cancers were more often with synchronous distal neoplasms (p ! 0.005). Majority of proximal, and distal cancers (66.9% and 79.4%) were detected without synchronous distal, and synchronous proximal neoplasms, respectively. Conclusion: A close relationship between the distributions of primary colorectal cancers and those of synchronous neoplasms was demonstrated. Careful attention should be paid more to the adjacent side compared with the distant side of the colon to find synchronous neoplasms at colorectal cancer resection.
www.mosby.com/gie