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DOI: 10.1055/s-0039-1681829
THE LOCATION AS A PREDICTOR OF ADENOCARCINOMA IN GRANULAR MIXED LATERALLY SPREADING TUMORS (GM-LSTS): A MULTICENTRE RESTROSPECTIVE ANALYSIS
Publication History
Publication Date:
18 March 2019 (online)
Aims:
GM-LSTs represent approximately 1/4 of all LST and have a submucosal invasion risk of approximately 10%. Size and location represent important predictor factors of advanced neoplasia. The aim of the study was to evaluate the prevalence of cancer in patients with GM-LSTs, analyzing factors of submucosal invasion risk such as size and location.
Methods:
Multicentric retrospective analysis of a prospectively maintained database of all consecutive patients with GM-LSTs that underwent endoscopic resection from 06/2014 to 10/2018 in five Italian centers.
Results:
A total of 581 patients (48,8% male; mean age 68.82 years) with GM-LSTs underwent endoscopic resection. The mean size of the GM-LSTs was 41,61 (range 18 – 150 mm). GM-LSTs were removed by: endoscopic mucosal resection (EMR) in 429 pts (73,8%) and endoscopic submucosal dissection (ESD) in 132 pts (22,7%). GM-LSTs were removed en-bloc in 114 cases (20%).
In 17 patients the GM-LSTs lesions were considered unfit for endoscopic resection and were referred to surgery. GM-LSTs were mainly located in the rectum (245, 42,2%) and in the right colon (245, 42,2%), while 48 lesions (8,2%) were in the left colon and 43 (7,4%) in the transverse colon. Histology showed low grade dysplasia (LGD) in 160 lesions (27,5%), high grade dysplasia (HGD) in 342 lesions (58,9%) and adenocarcinoma in 79 lesions (13,6%). When histology was analyzed according to lesion location the incidence of cancer was 18,8% (46/245) in the rectum vs. 9,8% (33/336) in the other colonic segments (p value = 0,001). Overall 41 (51.9%)pts with adenocarcinoma underwent surgery.
Conclusions:
Our study confirms the increased rate of adenocarcinoma in patients with GM-LSTs as highlighted in the literature and shows that the prevalence of cancer is significantly greater at the level of the rectum than in the other colonic segments. Further prospective multicentric studies are needed to define the best therapeutic approach for the removal of GM-LSTs.