Intestinal Research

Junseok Park

1 Article

Colorectal neoplasia

Clinical outcomes of positive resection margin after endoscopic mucosal resection of early colon cancers: Junseok Park, Hyun Gun Kim, Shin Ok Jeong, Hoon gil Jo, Hyo Yeop Song, Jeeyeon Kim, Seri Ryu, Youngyun Cho, Hyun Jin Youn, Seong Ran Jeon, Jin-Oh Kim, Bong Min Ko, Yoon Mi Jeen, So-Young Jin; Intest Res 2019;17(4):516-526. Published online May 31, 2019; DOI: https://doi.org/10.5217/ir.2018.00169

Background/Aims
When determining the subsequent management after endoscopic resection of the early colon cancer (ECC), various factors including the margin status should be considered. This study assessed the subsequent management and outcomes of ECCs according to margin status.
Methods
We examined the data of 223 ECCs treated by endoscopic mucosal resection (EMR) from 215 patients during 2004 to 2014, and all patients were followed-up at least for 2 years.
Results
According to histological analyses, the margin statuses of all lesions after EMR were as follows: 138 cases (61.9%) were negative, 65 cases (29.1%) were positive for dysplastic cells on the resection margins, and 20 cases (8.9%) were uncertain. The decision regarding subsequent management was affected not only by pathologic outcomes but also by the endoscopist’s opinion on whether complete resection was obtained. Surgery was preferred if the lesion extended to the submucosa (odds ratio [OR], 25.46; 95% confidence interval [CI], 7.09–91.42), the endoscopic resection was presumed incomplete (OR, 15.55; 95% CI, 4.28–56.56), or the lymph system was invaded (OR, 13.69; 95% CI, 1.76–106.57). Fourteen patients (6.2%) had residual or recurrent malignancies at the site of the previous ECC resection and were significantly associated with presumed incomplete endoscopic resection (OR, 4.59; 95% CI, 1.21–17.39) and submucosal invasion (OR, 5.14; 95% CI, 1.18–22.34).
Conclusions
Subsequent surgery was associated with submucosa invasion, lymphatic invasion, and cancer-positive margins. Presumed completeness of the resection may be helpful for guiding the subsequent management of patients who undergo endoscopic resection of ECC.

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