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Questionnaire Survey regarding Metastasis and Recurrence after Endoscopic Resection for T1(SM)Carcinomas:Results from JSCCR Project Research Yusuke Saitoh 1 , Shiro Oka 2 , Shinji Tanaka 2 , Yutaka Saito 3 , Hiroaki Ikematsu 4 , Masahiro Igarashi 5 , Yoshiki Wada 6 , Shin-ei Kudo 7 , Kiyonori Kobayashi 8 , Yuji Inoue 9 , Toshio Uraoka 10 , Hiroyasu Iishi 11 , Hiro-o Yamano 12 , Osamu Tsuruta 13 , Shinji Nagata 14 , Koichi Kurahara 15 , Yuichiro Yamaguchi 16 , Yasushi Sano 17 , Hiroshi Kashida 18 , Takahiro Horimatsu 19 , Shoichi Saitou 20 , Hideki Ueno 21 , Megumi Ishiguro 22 , Hideki Ishikawa 23 , Yoichi Ajioka 24 , Yasuo Ohkura 25 , Takahiro Fujimori 26 , Toshiaki Watanabe 27 , Kenichi Sugihara 22 1Digestive Disease Center, Asahikawa City Hospital, Asahikawa, Japan 2Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan 3Endoscopy Division, National Cancer Center Hospital, Tokyo 4Department of Gastroenterology Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Japan 5Department of Gastroenterology, Cancer Institute Hospital of JFCR, Tokyo 6Department of Endoscopy, Tokyo Medical and Dental University, Tokyo 7Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan 8Department of Gastroenterology, Kitasato University Hospital, Sagamihara, Japan 9Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo 10Division for Research and Development of Minor Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo 11Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan 12Department of Gastroenterology, Akita Red Cross Hospital, Akita, Japan 13Division of Gastroenterology, Department of Medicine, Kurume University, Kurume, Japan 14Department of Endoscopy, Hiroshima City Asa Hospital, Hiroshima, Japan 15Division of Gastroenterology, Matsuyama Red Cross Hospital, Matsuyama, Japan 16Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan 17Endoscopy Division, Gastrointestinal Center, Sano Hospital, Kobe, Japan 18Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kinki University Faculty of Medicine, Osakasayama, Japan 19Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan 20Department of Endoscopy, The Jikei University School of Medicine, Tokyo 21Department of Surgery, National Defense Medical College Hospital, Tokorozawa, Japan 22Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo 23Department of Molecular-Targeting Cancer Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan 24Department of Molecular and Diagnostic Pathology, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan 25Department of Pathology, Kyorin University School of Medicine, Tokyo 26Diagnostic Pathology Center, Shinko Hospital, Kobe, Japan 27Department of Surgical Oncology, The University of Tokyo, Tokyo Keyword: 大腸T1(SM)癌 , 内視鏡摘除 , 追加外科手術 , salvage治療 pp.448-456
Published Date 2015/4/25
DOI https://doi.org/10.11477/mf.1403200211
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 The recommendation for consideration of additional surgery after endoscopic resection for colorectal T1(SM)carcinomas is evaluated to be appropriate by Japan Society for Cancer of the Colon and Rectum(JSCCR)guidelines for the treatment of colorectal cancer ; however, additional surgery is still controversial as over surgery. This is because it is still unclear whether salvage therapy improves the prognosis when relapse or metastasis occur during the follow-up without additional surgery after endoscopic resection. The aim of this project was to elucidate the prognosis and the effectiveness of the salvage therapy in patients with relapse or metastasis during the follow-up after endoscopic resection alone or endoscopic resection with additional surgery. A retrospective questionnaire survey was performed and the results were analyzed for relapse cases during the period of 2001-2008. Results : 1)The number of cases dealt with during the period of 2001-2008, after endoscopic resection alone and with additional surgery were 101. The study comprised 62 males and 39 females whose average age at the initial endoscopic resection was 64.7 years. The location of endoscopic resection was the colon in 51 cases and rectum in 48 cases, macroscopic type was 68 cases of the polypoid type and 25 cases of flat and depressed type. The average size of the lesion was 22.1mm. As for the relapse pattern, cases of lymph node metastasis were 21, those of distant metastases were 45, and those of local recurrences in the deeper part of the submucosal layer were 35. 2)Excluding 6 cases of death due to other diseases and 5 cases of unknown prognosis, deaths due to cancer were seen in 54 cases(60%)among 90 follow-up relapse cases ; for 50% of these, the survival period was 39 months. Thus, prognosis was poor in the relapse cases. 3)In the 90 follow-up cases, there was no significant difference in the cumulative survival ratio between cases of endoscopic resection alone and those of endoscopic resection with additional surgery. 4)Prognosis was poor, regardless of the relapse pattern of lymph node metastasis, distant metastasis, and local recurrence of the deeper part of the submucosal layer. 5)The average survival period after relapse was significantly longer in patients with surgery for the relapsed disease compared with that in patients without surgery. The 36 survival cases reported included patients with surgery for the relapsed disease. 6). Local recurrence was the popular relapse pattern in cases with low risk factors for lymph node metastasis and in those with distant metastasis with high risk factors for lymph node metastasis ; however, no significant difference was seen. Conclusion : As the prognosis was poor in relapse patients after endoscopic resection for T1 cancers, regardless of the relapse pattern, patients with risk factors for lymph node metastasis should be cautiously evaluated for follow-up after endoscopic resection without additional surgery.


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