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The Middle or Long-term Outcome of Colorectal Carcinomas after Endoscopic Resection from the Viewpoint of Pathological Estimation for Surgical Margin Noriyuki Uesugi 1 , Takahisa Matsuda 2 , Ryouji Kushima 3 , Masao Andoh 4 , Shinji Tanaka 5 , Youichi Ajioka 6 , Tomio Arai 7 , Kiyoaki Homma 8 , Hiroo Yamano 9 , Takashi Yao 10 , Takayuki Matsumoto 11 , Takahiro Fujimori 12 , Kenichi Sugihara 13 , Tamotsu Sugai 1 1Department of Molecular Diagnostic Pathology, Iwate Medical University, School of Medicine, Morioka, Japan 2Endoscopy Division, National Cancer Center Hospital, Tokyo 3Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Otsu, Japan 4Department of Internal Medicine, Kanagami Hospital, Kanagami Jinyukai, Miyagi, Japan 5Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan 6Division of Molecular and Diagnostic Pathology, Niigata University, Graduate School of Medicine and Dental Sciences, Niigata, Japan 7Department of Pathology, Tokyo Metropolitan Geriatric Hospital, Tokyo 8Department of Therapeutic Endoscopy, Nihonkai General Hospital, Yamagata, Japan 9Department of Gastroenterology, Akita Red Cross Hospital, Akita, Japan 10Department of Pathology, Juntendo University, School of Medicine, Tokyo 11Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, School of Medicine, Morioka, Japan 12Pathology Center, Shinko Hospital, Kobe, Japan 13Koujinkai Daiichi Hospital. Tokyo, Japan Keyword: 大腸癌 , 内視鏡切除 , 側方断端 , 深部断端 pp.437-447
Published Date 2015/4/25
DOI https://doi.org/10.11477/mf.1403200210
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 Aims : Several problems have been pointed out for pathological diagnosis of surgical margins in microscopically resected colorectal specimens. In present study, we examined the relationship between(1)lateral margin,(2)vertical margin, and residual tumor tissue/local recurrence in microscopically resected colorectal specimens. Furthermore, we investigated the relationship between surgical margin and the interval of recurrence after microscopically resection.

 Materials and methods : Microscopically resected colorectal tumor showing Is, IIa and LST type macroscopically were enrolled.(1)Lateral margin : A total 81 cases of colorectal adenoma and intramucosal cancer with positive for lateral margin comprised those with follow-up intervals >6 months were examined. The relationship between histological differences of lateral margin and residual tumor tissue/local recurrence were investigated.(2)Vertical margin : A total 194 cases of microscopically resected colorectal carcinoma invading to the submucosa comprised those with follow-up intervals >6 months and those with colorectal resection after microscopic resection were enrolled. The relationship between residual cancer tissue/local recurrence and both clinicopathological features and distance to the vertical margin were investigated.

 Results : In cases with positive for lateral margin, 5 cases of local recurrence were found(5/81, 6.2%). In cases for examination of vertical margin, only 1 case of local recurrence was found(1/194, 0.6%), whereas no cases were found with residual cancer tissue in the surgically resected large intestine after microscopic resection. The recurrent case showed a negative vertical margin(pVM(−)). Among 22 cases with positive vertical margins(pVM(+)), no cases with local recurrence were found. Furthermore, the recurrent case showed distance to the vertical margin was 350μm, and no recurrence was found in cases with distance to the vertical margin >500μm.

 Conclusion :(1)In cases with positive for lateral margin, the recurrence will be occurred at a certain frequency, regardless of the histological differences in tumor component on margin.(2)The recurrence is less frequent in cases with distance from invasive front to vertical margin >500μm after microscopic resection ; therefore, this should be defined as the safety margin.


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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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