Annals of Coloproctology

Original Articles

Colorectal cancer

Are the width, length, depth, and area of submucosal invasion predictive of lymph node metastasis in pT1 colorectal cancer?: Olga Maynovskaia, Evgeny Rybakov, Stanislav Chernyshov, Evgeniy Khomyakov, Sergey Achkasov; Ann Coloproctol. 2023;39(6):484-492. Published online December 26, 2023; DOI: https://doi.org/10.3393/ac.2023.00087.0012

3,942 View
156 Download
2 Web of Science
2 Citations

Purpose
Submucosa-limited (pathological T1, pT1) colorectal cancers (CRCs) pose a continuing challenge in the choice of treatment options, which range from local excision to radical surgery. The aim of this study was to evaluate the morphometric and morphologic risk factors associated with regional lymph node metastasis (LNM) in pT1 CRC.
Methods
We performed a histological review of patients who underwent oncological resection between 2016 and 2022. Tumor grade, budding, poorly differentiated clusters (PDCs), cancer gland rupture, lymphovascular invasion (LVI), and presence of deep submucosal invasion (DSI), as well as width, length, total area, and area of DSI, were evaluated as potential risk factors for LNM.
Results
A total of 264 cases of colon and rectal carcinomas with invasion into the submucosal layer (pT1) were identified. LNM was found in 46 of the 264 cases (17.4%). All morphometric parameters, as well as DSI (P=0.330), showed no significant association with LNM. High grade adenocarcinoma (P=0.050), budding (P=0.056), and PDCs (P<0.001) were associated with LNM. In the multivariate analysis, LVI presence remained the only significant independent risk factor (odds ratio, 15.7; 95% confidence interval, 8.5–94.9; P<0.001).
Conclusion
The DSI of T1 CRC, as well as other morphometric parameters of submucosal tumor spread, held no predictive value in terms of LNM. LVI was the only independent risk factor of LNM.

Citations

Citations to this article as recorded by

IMMUNOREACT 8: Immune markers of local tumor spread in patients undergoing transanal excision for clinically N0 rectal cancer
Giulia Becherucci, Cesare Ruffolo, Melania Scarpa, Federico Scognamiglio, Astghik Stepanyan, Isacco Maretto, Andromachi Kotsafti, Ottavia De Simoni, Pierluigi Pilati, Boris Franzato, Antonio Scapinello, Francesca Bergamo, Marco Massani, Tommaso Stecca, An
Surgery.2025; 178: 108902. CrossRef
Long-term outcomes and lymph node metastasis following endoscopic resection with additional surgery or primary surgery for T1 colorectal cancer
Pin-Chun Chen, Yi-Kai Kao, Po-Wen Yang, Chia-Hung Chen, Chih-I Chen
Scientific Reports.2025;[Epub] CrossRef

The Risk Factors of Lymph Node Metastasis in Submucosal Invasive Colorectal Cancer.: Choi, Pyong Wha , Yu, Chang Sik , Jang, Se Jin , Kim, Mi Jung , Han, Kyong Rok , Jung, Sang Hun , Yoon, Yong Sik , Kim, Hee Cheol , Kim, Jin Cheon; J Korean Soc Coloproctol. 2006;22(4):264-270.

1,904 View
43 Download

Abstract PDF: PURPOSE
Recent studies have shown a 7~15% lymph node (LN) metastasis rate in submucosal invasive colorectal cancer (SICC). Identification of risk factors for LN metastasis is crucial in the choice of therapeutic modalities for SICC. The present study was performed to assess the possibility of LN metastasis and to determine the risk factors of LN metastasis in SICC.
METHODS
A retrospective study of 168 patients with SICC who underwent a curative resection between June 1989 and December 2004 at Asan Medical Center was conducted. The level of submucosal invasion was classified into upper third (sm1), middle third (sm2), and lower third (sm3) according to the submucosal depth of invasion. The following carcinoma-related variables were assessed: tumor size, tumor location, level of submucosal invasion, cell differentiation, lymphovascular invasion, neural invasion, and tumor cell dissociation (TCD).
RESULTS
The overall LN metastasis rate was 14.3%. According to the level of submucosal invasion, LN metastasis was seen as follows: sm1, n=4 (4.2%), sm2, n= 10 (21.3%), and sm3, n=10 (38.5%) (P=0.039). According to cell differentiation, LN metastasis was observed as follows: well-differentiated, n=4 (4.9%), moderately differentiated, n=19 (22.9%), and poorly differentiated, n=1 (25.0%) (P=0.028). Nineteen of the 66 cases (28.8%) with TCD had significantly higher risk of LN metastasis as did 5 of the 102 cases (4.9%) without TCD (P=0.045). No statistical difference was observed in the risk of LN metastasis with regard to tumor location, tumor size, neural invasion, or lymphovascular invasion.
CONCLUSIONS
Submucosal invasion, cell differentiation, and tumor cell dissociation were significant pathologic predictors of LN metastasis in SICC. As SICC has considerable risk of LN metastasis, local excision should be reserved to highly selective sm1 cancers.

First
Prev
Page of 1
Next
Last

Search