Relationship between indeterminate or positive lateral margin and local recurrence after endoscopic resection of colorectal polyps

Abstract

Background and study aims: Although endoscopic resection is widely used for the treatment of superficial colorectal neoplasms, the rate of local recurrence of lesions with a positive or indeterminate lateral margin on histologic evaluation is unclear. We aimed to demonstrate the relationship between lateral margin status and local recurrence after the endoscopic resection of intramucosal colorectal neoplasms.

Patients and methods: We retrospectively collected the clinical and pathologic data for 844 endoscopically resected colorectal intramucosal neoplasms with a size of 10 mm or larger. We investigated the relationship between the local recurrence rate and the lateral margin status (categorized as LM0 [negative], LM1 [positive], or LMX [indeterminate]).

Results: In total, 389 lesions were evaluated as LM0 and showed no local recurrence. Of the 455 lesions evaluated as LMX or LM1, 30 showed local recurrence within a median period of 6.3 months (range, 1.7 - 48.1) from the initial endoscopic resection. The local recurrence rate of the en bloc-LMX group (2.2 %) was significantly lower than that of the piecemeal-LMX group (15.2 %). Of the 30 cases of recurrence, 28 were successfully treated with a second endoscopic resection. Of the two lesions that showed further recurrence, one was treated with a third endoscopic resection, whereas the other - which was a piecemeal-LMX lesion - was eventually diagnosed as invasive cancer and treated with surgery.

Conclusions: The local recurrence rate was lower in the en bloc-LMX group than in the piecemeal-LMX group. Thus, we believe that en bloc-LMX lesions that are completely and confidently resected endoscopically can be treated as en bloc-LM0 lesions.

Fig. 1

Flowchart illustrating the inclusion criteria for the lesions examined in the present study of the relationship between an indeterminate or positive lateral margin and local recurrence after the endoscopic resection of colorectal polyps. PO, polypectomy; EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection; FAP, familial adenomatous polyposis; LS, Lynch syndrome; LM0, lateral margin free of tumor cells; LMX, glands at the lateral margin could not be evaluated; LM1, lateral margin positive for tumor cells.

Fig. 2

Flowchart illustrating the clinical course of the recurrent lesions. EMR, endoscopic mucosal resection; LMX, glands at the lateral margin could not be evaluated; ESD, endoscopic submucosal dissection; HB, hot biopsy; LM1, lateral margin positive for tumor cells; PO, polypectomy; CB, cold biopsy..

Fig. 3

Clinical course of a patient with a recurrent lesion. a A laterally spreading tumor, 50 mm in size, is detected in the cecum. b A piecemeal endoscopic mucosal resection (EMR) is performed to treat the lesion. c At 3 months after the piecemeal EMR, a recurrent lesion is detected at the site of the resection scar (arrow), which is then treated by hot biopsy. d After 8 months, further recurrence is noted (arrow). e Ileocecal resection is performed to treat the recurrent lesion.