Mateos Sanchez C, Quintanilla Lazaro E, Rabago LR. How secure can we expect the surveillance policies to be after the implementation in T1 polyps with carcinoma? World J Gastrointest Endosc 2024; 16(9): 502-508 [PMID: 39351175 DOI: 10.4253/wjge.v16.i9.502]
Corresponding Author of This Article
Luis Ramon Rabago, MD, PhD, Chief Physician, Department of Gastroenterology, Hospital San Rafael, Street Serrano 199, Madrid 28016, Spain. lrabagot@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Sep 16, 2024; 16(9): 502-508 Published online Sep 16, 2024. doi: 10.4253/wjge.v16.i9.502
How secure can we expect the surveillance policies to be after the implementation in T1 polyps with carcinoma?
Cristina Mateos Sanchez, Elvira Quintanilla Lazaro, Luis Ramon Rabago
Cristina Mateos Sanchez, Elvira Quintanilla Lazaro, Department of Gastroenterological, Severo Ochoa Hospital, Madrid, Leganes 28911, Spain
Luis Ramon Rabago, Department of Gastroenterology, San Rafael Hospital, Madrid 28016, Spain
Co-first authors: Cristina Mateos Sanchez and Elvira Quintanilla Lazaro.
Author contributions: Mateos Sanchez C oversaw the complete review and update of the topic, and wrote the preliminary Spanish and English drafts; Quintanilla Lazaro E assisted Mateos Sanchez C, gave her vision, helped Mateos Sanchez C with her tasks, reviewed the topic, and contributed various critical comments on the original article that made the editorial writing possible; Rabago LR made the final revision of all the tasks and provided the final critical comments on the original article, upon which this editorial has been written. Mateos Sanchez C and Quintanilla Lazaro E contributed equally to this work as co-first authors.
Conflict-of-interest statement: We do not have any conflict-of-interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Luis Ramon Rabago, MD, PhD, Chief Physician, Department of Gastroenterology, Hospital San Rafael, Street Serrano 199, Madrid 28016, Spain. lrabagot@gmail.com
Received: June 28, 2024 Revised: August 8, 2024 Accepted: August 20, 2024 Published online: September 16, 2024 Processing time: 75 Days and 8.4 Hours
Abstract
Approximately 7% of the polyps resected endoscopically have an adenocarcinoma focus, with no previous endoscopic evidence of malignancy. This raises the question of whether endoscopic resection has been curative. Furthermore, there is no consensus on what the endoscopic and histological criteria for good prognosis are, the appropriate follow-up strategy and what are the long-term results. The aim of the retrospective study by Fábián et al was to evaluate the occurrence of local relapse or distant metastasis in those tumors that were resected endoscopically compared to those that underwent oncologic surgery. They concluded that, regardless of the treatment strategy chosen, there was a higher recurrence rate than described in the literature and that adherence to follow-up was poor. The management approach for an endoscopically benign polyp histologically confirmed as adenocarcinoma depends on the presence of any of the previously described poor prognostic histological factors. If none of these factors are present and the polyp has been completely resected en bloc (R0), active surveillance is considered appropriate as endoscopic resection is deemed curative. These results highlight, once again, the need for further multicentric clinical practice studies to obtain more evidence for the purpose of establishing appropriate treatment and follow-up strategies.
Core Tip: The management of endoscopically benign polyps that histopathologically prove to contain pT1 adenocarcinoma is not defined, pending international definition of the required resection and histological criteria to be able to rely on a follow-up without surgery. Based on Fabian's study, it is very likely that the rate of complete resection and the risk of recurrence is much higher than previously published and that we must also consider the risk of insufficient therapy. The follow-up of these patients remains to be clarified and agreed upon in multicenter studies that will make it possible to obtain more data at least for clinical practice and, above all, to insist on the potential risk for survival when patients are lost in follow-up programs.
