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Yun Sik Choi (Asan Medical Center) Wan Soo Kim (Gyeongsang National University Changwon Hospital) Sung Wook Hwang (Asan Medical Center) Sang Hyoung Park (Asan Medical Center) Dong-Hoon Yang (Asan Medical Center) 예병덕 (울산대학교) 명승재 (울산대학교) 양석균 (울산대학교) 변정식 (울산대학교)
저널정보
대한장연구학회 Intestinal research Intestinal research Vol.18 No.1
발행연도
2020.1
수록면
96 - 106 (11page)

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Background/Aims: We aimed to investigate the proportion of and risk factors for residual cancer and/or lymph node metastasis after surgery was performed because of high-risk pathological features in endoscopic resection specimen of suspected superficial submucosal colorectal cancer (SSMC). Methods: We reviewed medical records of 497 patients (58.8±9.8 years, 331 males) undergoing endoscopic resection of suspected SSMC. High-risk pathological features included: deep submucosal cancer invasion ≥1,000 μm; positive lymphovascular and/or perineural invasion; poorly differentiated adenocarcinoma; and positive resection margin. We investigated the occurrence of additional surgery and residual cancer and/or lymph node involvement in the surgical specimen. Results: En bloc resection was performed in 447 patients (89.9%). High-risk pathological features were detected in 372 patients (74.8%). Additional surgery was performed in 336 of 372 patients with high-risk pathological features. Of these, 47 surgical specimens (14.0%) showed residual cancer and/or lymph node metastasis. Piecemeal resection was more common in those with residual cancer and/or lymph node involvement than those without (9/47 [19.1%] vs. 24/289 [8.3%], P=0.032). Positive resection margin was also significantly associated with positive residual cancer and/or lymph node involvement. As the number of high-risk pathological features increased, the risk of regional lymph node metastasis increased proportionally (P=0.002). Conclusions: High-risk pathological features were frequently detected after endoscopic resection of suspected SSMC while residual cancer and/or lymph node metastasis were not commonly present in the additional surgical specimen. Further optimized strategy for proper endoscopic management of suspected SSMC is necessary.

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