Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm

Background: A colorectal neoplasm that spreads superficially over the mucosa is known as a laterally spreading tumor. The clinicopathologic features of these large lesions and the efficacy and safety of endoscopic mucosal resection (EMR) were studied retrospectively. Methods: Surgically or endoscopi...

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Veröffentlicht in:Gastrointestinal endoscopy 2001-07, Vol.54 (1), p.62-66
Hauptverfasser: Tanaka, Shinji, Haruma, Ken, Oka, Shiro, Takahashi, Ryoji, Kunihiro, Masaki, Kitadai, Yasuhiko, Yoshihara, Masaharu, Shimamoto, Fumio, Chayama, Kazuaki
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Sprache:eng
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Zusammenfassung:Background: A colorectal neoplasm that spreads superficially over the mucosa is known as a laterally spreading tumor. The clinicopathologic features of these large lesions and the efficacy and safety of endoscopic mucosal resection (EMR) were studied retrospectively. Methods: Surgically or endoscopically resected laterally spreading tumors larger than 20 mm in diameter were studied. Lesions were divided into 2 macroscopic subtypes: F-type, composed of superficially spreading lesions with a flat and smooth surface, and G-type, composed of superficially spreading aggregates of nodules that form relatively flat, broad-based lesions with granulonodular and uneven surfaces. Results: Thirty-three lesions were of the F-type and 87 the G-type. G-type (mean ± SD, 35.3 ± 11.4 mm) lesions were significantly larger (p < 0.01) than F-type (26.0 ± 7.2 mm) lesions. F-type lesions had a significantly higher frequency of invasive cancer (27.2%) than G-types (10.3%)(p < 0.05). Of the 120 lesions, 81 (67.5%) were resected endoscopically. Patients with 78 of these lesions were followed postoperatively for 60.8 ± 20.1 months. The rate of local recurrence of endoscopically treated tumors as determined at colonoscopy was 7.4% (6/78). These lesions were completely resected endoscopically. Distant metastases were not detected. Thirteen (16.0%) patients had local bleeding after EMR that was stopped endoscopically. Microperforation of the colonic wall as a result of EMR was diagnosed in 1 (1.2%) of 81 cases. Conclusions: Laterally spreading tumors larger than 20 mm, especially those of the G-type, have a low rate of invasion despite their relatively large size. The F-type lesion has a higher malignant potential than the G-type. EMR is an effective and safe treatment for the large laterally spreading tumor. (Gastrointest Endosc 2001;54:62-6.)
ISSN:0016-5107
1097-6779
DOI:10.1067/mge.2001.115729