Please use this identifier to cite or link to this item: http://hdl.handle.net/11434/1273
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dc.contributor.authorBrown, Gregor-
dc.contributor.otherBurgess, Nicholas-
dc.contributor.otherHourigan, Luke-
dc.contributor.otherZanati, Simon-
dc.contributor.otherSingh, R.-
dc.contributor.otherWilliams, Stephen-
dc.contributor.otherRaftopoulos, Spiro-
dc.contributor.otherOrmonde, D.-
dc.contributor.otherMoss, A.-
dc.contributor.otherBlyth, K.-
dc.contributor.otherMahajan, H.-
dc.contributor.otherMcLeod, D.-
dc.contributor.otherBourke, Michael-
dc.date.accessioned2017-11-27T02:55:11Z-
dc.date.available2017-11-27T02:55:11Z-
dc.date.issued2017-09-
dc.identifier.citationGastroenterology. 2017 Sep;153(3):732-742.e1.en_US
dc.identifier.issn0016-5085en_US
dc.identifier.urihttp://hdl.handle.net/11434/1273-
dc.description.abstractBACKGROUND & AIMS: Among patients with large colorectal sessile polyps or laterally spreading lesions, it is important to identify those at risk for submucosal invasive cancer (SMIC). Lesions with overt endoscopic evidence of SMIC are referred for surgery, although those without these features might still contain SMIC that is not visible on endoscopic inspection (covert SMIC). Lesions with a high covert SMIC risk might be better suited for endoscopic submucosal dissection than for endoscopic mucosal resection (EMR). We analyzed a group of patients with large colon lesions to identify factors associated with SMIC, and examined lesions without overt endoscopic high-risk signs to determine factors associated with covert SMIC. METHODS: We performed a prospective cohort study of consecutive patients referred for EMR of large sessile or flat colorectal polyps or laterally spreading lesions (≥20 mm) at academic hospitals in Australia from September 2008 through September 2016. We collected data on patient and lesion characteristics, outcomes of procedures, and histology findings. We excluded serrated lesions from the analysis of covert SMIC due to their distinct phenotype and biologic features. RESULTS: We analyzed 2277 lesions (mean size, 36.9 mm) from 2106 patients (mean age, 67.7 years; 53.2% male). SMIC was evident in 171 lesions (7.6%). Factors associated with SMIC included Kudo pit pattern V, a depressed component (0-IIc), rectosigmoid location, 0-Is or 0-IIa+Is Paris classification, non-granular surface morphology, and increasing size. After exclusion of lesions that were obviously SMIC or serrated, factors associated with covert SMIC were rectosigmoid location (odds ratio, 1.87; P = .01), combined Paris classification, surface morphology (odds ratios, 3.96-22.5), and increasing size (odds ratio, 1.16/10 mm; P = .012). CONCLUSIONS: In a prospective study of 2106 patients who underwent EMR for large sessile or flat colorectal polyps or laterally spreading lesions, we associated rectosigmoid location, combined Paris classification and surface morphology, and increasing size with increased risk for covert malignancy. Rectosigmoid 0-Is and 0-IIa+Is non-granular lesions have a high risk for malignancy, whereas proximally located 0-Is or 0-IIa granular lesions have a low risk. These findings can be used to inform decisions on which patients should undergo endoscopic submucosal dissection, EMR, or surgery.en_US
dc.publisherElsevieren_US
dc.subjectColon Canceren_US
dc.subjectPredictionen_US
dc.subjectPrognostic Factoren_US
dc.subjectTumoren_US
dc.subjectTumouren_US
dc.subjectColorectal Sessile Polypsen_US
dc.subjectLaterally Spreading Lesionsen_US
dc.subjectSubmucosal Invasive Canceren_US
dc.subjectSMICen_US
dc.subjectCovert SMICen_US
dc.subjectEndoscopic Submucosal Dissectionen_US
dc.subjectEndoscopic Mucosal Resectionen_US
dc.subjectEMRen_US
dc.subjectKudo Pit Patternen_US
dc.subjectParis Classificationen_US
dc.subjectRectosigmoid Locationen_US
dc.subjectGeneral Surgery and Gastroenterology Clinical Institute, Epworth HealthCare, Victoria, Australiaen_US
dc.subjectCancer Services Clinical Institute, Epworth HealthCare, Victoria, Australiaen_US
dc.titleRisk stratification for covert invasive cancer among patients referred for colonic endoscopic mucosal resection: A large multicenter cohort.en_US
dc.typeJournal Articleen_US
dc.identifier.doi10.1053/j.gastro.2017.05.047en_US
dc.identifier.journaltitleGastroenterologyen_US
dc.description.pubmedurihttps://www.ncbi.nlm.nih.gov/pubmed/28583826en_US
dc.description.affiliatesDepartment of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australiaen_US
dc.description.affiliatesDepartment of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australiaen_US
dc.description.affiliatesDepartment of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Victoria, Australiaen_US
dc.description.affiliatesWestmead Clinical School, University of Sydney, School of Medicine, Sydney, New South Wales, Australiaen_US
dc.description.affiliatesGallipoli Medical Research Institute, School of Medicine, The University of Queensland, Greenslopes Private Hospital, Brisbane, Queensland, Australiaen_US
dc.description.affiliatesDepartment of Gastroenterology and Hepatology, Western Hospital, Melbourne, Victoria, Australiaen_US
dc.description.affiliatesDepartment of Gastroenterology and Hepatology, Lyell McEwin Hospital, Adelaide, South Australia, Australiaen_US
dc.description.affiliatesDepartment of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.en_US
dc.description.affiliatesUniversity of Sydney National Health and Medical Research Council Clinical Trials Centre, Sydney, New South Wales, Australia.en_US
dc.description.affiliatesInstitute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia.en_US
dc.type.studyortrialMulticentre Studiesen_US
dc.type.contenttypeTexten_US
Appears in Collections:Cancer Services
General Surgery and Gastroenterology

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