Hao XW, Li P, Wang YJ, Ji M, Zhang ST, Shi HY. Predictors for malignant potential and deep submucosal invasion in colorectal laterally spreading tumors. World J Gastrointest Oncol 2022; 14(7): 1337-1347 [PMID: 36051097 DOI: 10.4251/wjgo.v14.i7.1337]
Corresponding Author of This Article
Hai-Yun Shi, MD, PhD, Associate Professor, National Clinical Research Centre for Digestive Disease, Beijing Digestive Disease Centre, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, Beijing 100050, China. shihaiyun1016@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
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 Oncol. Jul 15, 2022; 14(7): 1337-1347 Published online Jul 15, 2022. doi: 10.4251/wjgo.v14.i7.1337
Predictors for malignant potential and deep submucosal invasion in colorectal laterally spreading tumors
Xiao-Wen Hao, Peng Li, Yong-Jun Wang, Ming Ji, Shu-Tian Zhang, Hai-Yun Shi
Xiao-Wen Hao, Peng Li, Yong-Jun Wang, Ming Ji, Shu-Tian Zhang, Hai-Yun Shi, National Clinical Research Centre for Digestive Disease, Beijing Digestive Disease Centre, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Shi HY designed the research study and performed the data collection; Hao XW analyzed the data and wrote the first draft of the manuscript; Li P, Wang YJ, Ji M and Zhang ST performed the endoscopic therapies; Shi HY reviewed and edited the manuscript; and all authors read and approved the final manuscript.
Supported byBeijing Nova Program, No. Z201100006820147; and Beijing Municipal Administration of Hospitals’ Youth Program, No. QML20180102.
Institutional review board statement: This study was approved by the Ethics Committee of Beijing Friendship Hospital (2020-P2-047-01) and was performed in accordance with the ethical guidelines of the 1975 Declaration of Helsinki.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
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: Hai-Yun Shi, MD, PhD, Associate Professor, National Clinical Research Centre for Digestive Disease, Beijing Digestive Disease Centre, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, Beijing 100050, China. shihaiyun1016@gmail.com
Received: March 15, 2022 Peer-review started: March 15, 2022 First decision: May 10, 2022 Revised: May 24, 2022 Accepted: June 22, 2022 Article in press: June 22, 2022 Published online: July 15, 2022 Processing time: 119 Days and 16 Hours
ARTICLE HIGHLIGHTS
Research background
The incidence of laterally spreading tumors (LSTs) is continually increasing; however, the optimal strategy for resecting large colorectal LSTs is still under debate. Endoscopic submucosal dissection (ESD) is associated with a high en bloc resection rate, low risk of recurrence and perfect pathological analysis. However, the possibility of a positive postoperative pathological resection margin exists, which would require additional surgical procedures. Surgery has a high complication rate, high mortality and prolonged hospital stays.
Research motivation
Accurate preoperative assessment based on various risk factors to identify carcinoma and invasion depth is essential for selecting an appropriate therapeutic strategy.
Research objectives
This study aimed to identify the predictors of carcinoma, invasion depth and endoscopically unresectable lesions for colorectal LSTs and to facilitate appropriate preoperative selection.
Research methods
This retrospective study analysed the endoscopic and histological results of consecutive patients who underwent ESD for colorectal LSTs in our hospital during a six-year period. The characteristics of the LSTs were compared by subtypes. Risk factors for high-grade dysplasia (HGD)/carcinoma and deep submucosal invasion (SMI) (invasion depth ≥ 1000 μm) were determined for each morphologic subtype.
Research results
Among the four subtypes, non-granular pseudodepressed (NG-PD) LSTs had the highest rate of HGD/carcinoma and deep SMI (invasion depth ≥ 1000 μm). NG-PD subtype and rectosigmoid location were the independent risk factors for deep SMI in adjusted multivariate analysis.
Research conclusions
We demonstrated that it is highly recommend that NG-PD and granular nodular mixed (G-NM) LSTs are removed through ESD; given their substantial risk for deep SMI, surgery needs to be considered in NG-PD LSTs located in the rectosigmoid, especially those with positive non-lifting signs.
Research perspectives
A risk score chart, which can determine the risk for carcinoma, invasion depth and endoscopically unresectable lesions for colorectal LSTs should be developed. It can help endoscopists in selective use of different types of endo-resection or to proceed to surgery instead of endoscopy.
