Prevalence of Endoscopically Curable Low-Risk Cancer amongst Large (≥20mm) Non-Pedunculated Polyps in the Right Colon.

Colorectal Cancer Endoscopic Mucosal Resection Endoscopic Submucosal Dissection Large Non-Pedunculated Colorectal Polyps

Journal

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
ISSN: 1542-7714
Titre abrégé: Clin Gastroenterol Hepatol
Pays: United States
ID NLM: 101160775

Informations de publication

Date de publication:
30 Jul 2024
Historique:
received: 12 05 2024
revised: 07 07 2024
accepted: 08 07 2024
medline: 2 8 2024
pubmed: 2 8 2024
entrez: 1 8 2024
Statut: aheadofprint

Résumé

Endoscopic submucosal dissection (ESD) is increasingly promoted for the treatment of all large non-pedunculated colorectal polyps (LNPCP), to cure potential low-risk cancers (superficial submucosal invasion without additional high-risk histopathological features). The effect of a universal en bloc strategy on oncological outcomes for the treatment of LNPCP in the right colon is unknown. We evaluated this in a large Western population. A prospective cohort of patients referred for endoscopic resection (ER) of LNPCP was analysed. Patients found to have cancer after ER and those referred directly to surgery were included. The primary outcome was to determine the proportion of right colon LNPCP with low-risk cancer. Over 180 months until June 2023, 3294 sporadic right colon LNPCP in 2956 patients were referred for ER at 7 sites (median size 30mm [IQR 15]). 63 (2.1%) patients were referred directly to surgery and cancer was proven in 56 (88.9%). 2851/2956 (96.4%) LNPCP underwent ER (median size 35mm [IQR 20]) of which 75 (2.6%) were cancers. The overall prevalence of cancer in the right colon was 4.4% (131/2956). Detailed histopathological analysis was possible in 115/131 (88%) cancers (71 after ER, 44 direct to surgery). After excluding missing histopathological data, 23/2940 (0.78%) sporadic right colon LNPCP were low-risk cancers. The proportion of right colon LNPCP referred for ER containing low-risk cancer amenable to endoscopic cure was <1%, in a large, multicentre Western cohort. A universal ESD strategy for the management of right colon LNPCP is unlikely to yield improved patient outcomes given the minimal impact on oncological outcomes. Australian Colonic Endoscopic Resection (ACE) cohort: NCT01368289 (https://classic. gov/ct2/show/NCT01368289); NCT02000141 (https://classic. gov/ct2/show/NCT02000141).

Sections du résumé

BACKGROUND AND AIMS OBJECTIVE
Endoscopic submucosal dissection (ESD) is increasingly promoted for the treatment of all large non-pedunculated colorectal polyps (LNPCP), to cure potential low-risk cancers (superficial submucosal invasion without additional high-risk histopathological features). The effect of a universal en bloc strategy on oncological outcomes for the treatment of LNPCP in the right colon is unknown. We evaluated this in a large Western population.
METHODS METHODS
A prospective cohort of patients referred for endoscopic resection (ER) of LNPCP was analysed. Patients found to have cancer after ER and those referred directly to surgery were included. The primary outcome was to determine the proportion of right colon LNPCP with low-risk cancer.
RESULTS RESULTS
Over 180 months until June 2023, 3294 sporadic right colon LNPCP in 2956 patients were referred for ER at 7 sites (median size 30mm [IQR 15]). 63 (2.1%) patients were referred directly to surgery and cancer was proven in 56 (88.9%). 2851/2956 (96.4%) LNPCP underwent ER (median size 35mm [IQR 20]) of which 75 (2.6%) were cancers. The overall prevalence of cancer in the right colon was 4.4% (131/2956). Detailed histopathological analysis was possible in 115/131 (88%) cancers (71 after ER, 44 direct to surgery). After excluding missing histopathological data, 23/2940 (0.78%) sporadic right colon LNPCP were low-risk cancers.
CONCLUSIONS CONCLUSIONS
The proportion of right colon LNPCP referred for ER containing low-risk cancer amenable to endoscopic cure was <1%, in a large, multicentre Western cohort. A universal ESD strategy for the management of right colon LNPCP is unlikely to yield improved patient outcomes given the minimal impact on oncological outcomes.
CLINICAL TRIAL BACKGROUND
Australian Colonic Endoscopic Resection (ACE) cohort: NCT01368289 (https://classic.
CLINICALTRIALS RESULTS
gov/ct2/show/NCT01368289); NCT02000141 (https://classic.
CLINICALTRIALS RESULTS
gov/ct2/show/NCT02000141).

Identifiants

DOI: 10.1016/j.cgh.2024.07.017 PMID: 39089517
pubmed: 39089517
pii: S1542-3565(24)00686-4
doi: 10.1016/j.cgh.2024.07.017
pii:
doi:

Banques de données

ClinicalTrials.gov
['NCT01368289', 'NCT02000141']

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.

Auteurs

Julia L Gauci (JL)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney.

Anthony Whitfield (A)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney; The University of Sydney, Westmead Clinical School of Medicine, Sydney, Australia.

Renato Medas (R)

Centro Hospitalar e Universitario Sao Joao, Porto, Portugal; Faculty of Medicine of University of Porto, Portugal.

Clarence Kerrison (C)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney; The University of Sydney, Westmead Clinical School of Medicine, Sydney, Australia.

Francesco Vito Mandarino (FV)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney.

David Gibson (D)

Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Gastroenterology and Hepatology, Epworth Hospital, Melbourne, VIC, Australia.

Timothy O'Sullivan (T)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney; The University of Sydney, Westmead Clinical School of Medicine, Sydney, Australia.

Oliver Cronin (O)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney; The University of Sydney, Westmead Clinical School of Medicine, Sydney, Australia.

Sunil Gupta (S)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney; The University of Sydney, Westmead Clinical School of Medicine, Sydney, Australia.

Brian Lam (B)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney.

Varan Perananthan (V)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney.

Luke Hourigan (L)

Department of Gastroenterology, Princess Alexandra Hospital (Queensland Health), Brisbane, Queensland, Australia.

Simon Zanati (S)

Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Gastroenterology and Hepatology, Epworth Hospital, Melbourne, VIC, Australia.

Rajvinder Singh (R)

Department of Gastroenterology and Hepatology, Lyell McEwan Hospital, Adelaide, South Australia, Australia.

Spiro Raftopoulos (S)

Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Australia.

Alan Moss (A)

Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Gastroenterology and Hepatology, Epworth Hospital, Melbourne, VIC, Australia.

Gregor Brown (G)

Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Gastroenterology and Hepatology, Epworth Hospital, Melbourne, VIC, Australia.

Amir Klein (A)

Ambam Heath Care Campus, Technion Institute of Technology, Haifa, Israel; Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.

Lobke Desomer (L)

AZ Delta Roeselare, University Hospital Ghent, Ghent, Belgium.

David J Tate (DJ)

Department of Gastroenterology and Hepatology, University Hospital of Ghent, Ghent, Belgium; Faculty of Medicine, University of Ghent, Ghent, Belgium.

Steven J Williams (SJ)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney.

Eric Y Lee (EY)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney; The University of Sydney, Westmead Clinical School of Medicine, Sydney, Australia.

Nicholas Burgess (N)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney; The University of Sydney, Westmead Clinical School of Medicine, Sydney, Australia.

Michael J Bourke (MJ)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney; The University of Sydney, Westmead Clinical School of Medicine, Sydney, Australia. Electronic address: michael@citywestgastro.com.au.

Classifications MeSH