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Lee, Jeong, Park, Hong, Nam, Moon, Lee, Kim, Sung, and Lee: Follow-up Results of Endoscopic Mucosal Resection for Early Colorectal Cancer
Original Article

Korean J Gastroenterol 2011;57(4):230-236.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.57.4.230

Follow-up Results of Endoscopic Mucosal Resection for Early Colorectal Cancer

Hee Jung Lee, Hyun Yong Jeong, Nam Hwan Park, Sun Chang Hong, Gwan Woo Nam, Hee Seok Moon, Eaum Seok Lee, Seok Hyun Kim, Jae Kyu Sung, Byung Seok Lee

Department of Internal Medicine, Chungnam National Univertisity College of Medicine, Daejeon, Korea

Correspondence to: Hyun Yong Jeong, Department of Internal Medicine, Chungnam National Univertisity College of Medicine, 640, Daesa-dong, Jung-gu, Daejeon 301-721, Korea. Tel: +82-42-280-7163, Fax: +82-42-257-5753, E-mail: Jeonghy@cnuh.co.kr

Received 13 April 2010       Revised 31 December 2010       Accepted 31 December 2010

Copyright © 2011 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Recently colonoscopy and screening programs have led to the detection and removal of increasing numbers of early colorectal cancer (ECC), which can reduce its related mortality. We analysed the clinical, endoscopic, and histologic findings, as well as the follow-up data, to evaluate the effectiveness and the long-term results of endoscopic mucosal resection (EMR) for ECC.

Methods

We analysed, retrospectively, 94 lesions in 92 patients who underwent EMR for ECC from January 2002 to June 2009.

Results

The overage age of patients was 60 years old. The mean follow-up period was 22.1 months (6–80). En bloc resection rate was 64.9%. Submucosal invasion was found in 30 cases (31.9%). De novo cancer rate was 26.6% which had higher submucosal invasion rate (60%, p=0.003). The complete resection rate was 87.2%, and there was no recurrence of cancer during follow-up (p=0.000). Twelve incomplete resection cases had received further surgical treatments. No procedure-related mortality was found and no recurrent malignancy was found except 1 case.

Conclusions

This study shows that EMR is an effective and safe treatment for ECC. En bloc resection provides precise histologic information and prevention of tumor recurrence.

Keywords: Early colorectal cancer, Colonoscopy, Mucosal resection

References

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Table 1.
Age and Sex Distribution
Age Male (%) Famale (%) Total (%)
30–39 2 (2.2) 1 (1.1) 3 (3.3)
40–49 2 (2.2) 5 (5.4) 7 (7.6)
50–59 25 (27.2) 2 (2.2) 27 (29.3)
60–69 29 (31.5) 10 (10.9) 39 (42.4)
70–79 8 (8.7) 7 (7.6) 15 (16.3)
≥80   1 (1.1) 1 (1.1)
  66 (71.7) 26 (28.3) 92 (100)
Table 2.
Clinical Characteristics of Early Colorectal Cancer
Tumor M cancer (%) SM cancer (%) Total (%)
Size      
  <10 mm 7 (7.4) 4 (4.3) 11 (11.7)
  10–19 mm 26 (27.7) 16 (17.0) 42 (44.7)
  ≥20 mm 31 (33.0) 10 (10.6) 41 (43.6)
Site      
  Rectum 35 (37.2) 9 (9.6) 44 (46.8)
  Sigmoid 15 (17.2) 11 (11.7) 26 (27.7)
  Descending 6 (6.4) 2 (2.1) 8 (8.5)
  Transverse 3 (3.2) 4 (4.3) 7 (7.4)
  Ascending 3 (3.2) 3 (3.2) 6 (6.4)
  Cecum 2 (2.1) 1 (1.1) 3 (3.2)
Morphology      
  Pedunculated 30 (31.9) 13 (13.8) 43 (45.7)
  Subpedunculated 17 (18.1) 7 (7.4) 24 (25.5)
  Sessile 10 (10.6) 7 (7.4) 17 (18.1)
  LST 7 (7.4) 3 (3.2) 10 (10.6)
    64 (68.1) 30 (31.9) 94

M, mucosa; SM, submucosa; LST, laterally spreading tumor.

Table 3.
Endoscopic Features of Colorectal Cancer
Features M cancer SM cancer Total
Surface nodularity 7 4 11
Lobulation 28 16 44
Depression   4 4
Bleeding 1 1 2
Redness 47 23 70
Whitish spots 8 4 12

M, mucosa; SM, submucosa.

Table 4.
Types of Endoscopic Mucosal Resection for Early Colorectal Cancer
  En-bloc Piecemeal Total p-value
Size       0.024
  <10 mm 10 1 11  
  10–19 mm 30 12 42  
  ≥20 mm 21 20 41 0.000
Morphology        
  Pedunculated 34 9 43  
  Subpedunculated 18 6 24  
  Sessile 9 8 17  
  LST 59 10 10  
Resection margins       0.001
  Negative 2 23 82  
  Positive   5 7  
  Unclear   5 5  
Lymphovascular       NS
  involvement        
  Negative 57 29 86  
  Positive 4 4 8  

LST, laterally spreading tumor; NS, non significant.

Table 5.
Characteristics of Early Colorectal Cancer, Based on Re-section Margins after Endoscopic Resection
  Resection margins p-value
Negative Positive Unclear
Depth of Invasion       0.000
  Mucosa 62   2  
  Submucosa 20 7 3  
Size       NS
  <10 mm 11      
  10–19 mm 37 3 2  
  ≥20 mm 34 4 3  
Morphology       NS
  Pedunculated 40 2 1  
  Subpedunculated 21 3    
  Sessile 13 2 2  
  LST 8   2  
Total (n=94) 82 7 5  

LST, laterally spreading tumor; NS, non significant.

Table 6.
Characteristics of Early Colorectal Cancer according to Background Histology
  Back ground histology Total p-value
None T TV V
Depth of Invasion           0.003
Mucosa 10 28 22 4 64  
Submucosa 15 5 8 2 30  
Size           NS
<10 mm 4 5 2   11  
10–19 mm 14 14 11 3 42  
≥20 mm 7 14 17 3 41  
Morphology           NS
Pedunculated 5 16 17 5 43  
Subpedunculated 9 7 8   24  
Sessile 5 7 4 1 17  
LST 6 3 1   10  
Resection margins           0.007
Negative 17 31 29 5 82  
Positive 6   1   7  
Unclear 2 2   1 5  
Lymphovascular           0.010
involvement            
Negative 19 31 30 6 86  
Positive 6 2     8  

T, tubular adenoma; TV, tubulovillous adenoma; V, villous adenoma

LST, laterally spreading tumor; NS, non significant.

Table 7.
Characteristics of Early Colorectal Cancer, Based on Residual Cancer after Endoscopic Mucosal Resection
  Residual tumor a p-value
Negative (%) Positive (%)
Depth of invasion     0.030
  Mucosa 64 (68.1)    
  Submucosa 27 (28.7) 3 (3.2)  
Resection margins     0.000
  Negative 82 (87.2)    
  Positive 4 (4.3) 3 (3.2)  
  Unclear 5 (5.3)    
Background histology     0.017
  None 22 (23.4) 3 (3.2)  
  Adenomas 69 (73.4)    

a Residual tumor after additional operation or recurrence.

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