Endoscopy 2020; 52(S 01): S227-S228
DOI: 10.1055/s-0040-1704711
ESGE Days 2020 ePoster Podium presentations
Saturday, April 25, 2020 14:30 – 15:00 Indications and detection at colonoscopy ePoster Podium 4
© Georg Thieme Verlag KG Stuttgart · New York

NON-INVASIVE COLORECTAL NEOPLASMS REFERRED TO SURGERY: A PERFORMANCE KEY MEASURE FOR SCREENING PROGRAMS

F Iacopini
1   Ospedale dei Castelli, ASL Roma6, Gastroenterology and Endoscopy Unit, Ariccia, Rome, Italy
,
C Hassan
2   Gastroenterology, Osp. Nuovo Regina Margherita, Rome, Italy
,
S Frontespezi
3   Pol. Di Liegro, Rome, Italy
,
E Mattei
4   Osp. Pertini, Rome, Italy
,
V Ceci
5   Osp. PertiniS. Maria Goretti, Latina, Italy
,
S Brighi
6   Osp. Spaziani, Frosinone, Italy
,
P Fedeli
7   Osp. S. Spirito, Rome, Italy
,
S Angeletti
8   Osp. S. Andrea, Rome, Italy
,
G Fanello
9   Endoscopy Unit, Civitavecchia, Italy
,
V D’Ovidio
10   Osp. S. Eugenio, Rome, Italy
,
MG De Palo
11   Osp. Belcolle, Viterbo, Italy
,
A Cocco
4   Osp. Pertini, Rome, Italy
,
A Forte
3   Pol. Di Liegro, Rome, Italy
,
G Forti
12   Osp. S. Maria Goretti, Latina, Italy
,
C Grossi
13   Ospedale dei Castelli, ASL Roma6, Rome, Italy
,
N Altavilla
6   Osp. Spaziani, Frosinone, Italy
,
G Dimito
14   Osp. Civitavecchia, Civitavecchia, Italy
,
G Occhigrossi
4   Osp. Pertini, Rome, Italy
,
E Di Giulio
8   Osp. S. Andrea, Rome, Italy
,
M Bazuro
10   Osp. S. Eugenio, Rome, Italy
,
R Ballanti
7   Osp. S. Spirito, Rome, Italy
,
R Faggiani
11   Osp. Belcolle, Viterbo, Italy
,
A Scozzarro
13   Ospedale dei Castelli, ASL Roma6, Rome, Italy
,
E Capezzuto
15   Osp. Grassi, Ostia, Rome, Italy
,
F Baldi
16   Osp. Tarquinia, Tarquinia, Italy
,
D Baiocchi
17   Screening, Area Prevenzione e Promozione della Salute, Regione Lazio, Rome, Italy
,
A Barca
17   Screening, Area Prevenzione e Promozione della Salute, Regione Lazio, Rome, Italy
,
G Costamagna
18   Pol. Gemelli, Univ. Cattolica, Rome, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims A large proportion of neoplasms undergo curative endoscopic resection if second-look is performed before surgery. Operator competency and limited access to advanced resection techniques may have an unfavorable impact on colorectal cancer screening.

Methods Observational, multicenter study including all screening centers in a central Italy, and all patients referred to surgery due a colorectal cancer. Data were retrieved both from county registry and endoscopic charts. Primary outcome: noninvasive cancer rate (tumor not invading the submucosa on endoscopic or surgical specimens). Neoplasms were stratified at endoscopy by Paris and Borrmann classifications in superficial and deep. Secondary outcome: indefinite cancer histologic diagnosis on ER specimens (no data on submucosal invasion; indefinite T1 microstaging).

Results 468 neoplasms from 13 centers defined as superficial in 188 cases and deep in 280. Superficial neoplasms underwent ER (Sup-ER) in 92 (49%), and biopsies in 96 (Sup-B) (51%). Sup-ER were smaller (P < 0.0001), more pedunculated (P < 0.0001), and in the left colon (P < 0.0001) than Sup-B. ER was complete in 76 (83%): en bloc in 45 (59%), piecemeal in 31 (41%). Noninvasive cancer rate of Sup-B (40%) was higher than Sup-ER (20%, P < 0.01); that of ulcer-negative Deep-B (20%) was higher than ulcer-positive (5%) and stricturing Deep-B (3%; P = 0.0002). Indefinite cancer histologic diagnosis rate was higher in Sup-ER underwent incomplete resection (50% vs.20%; P = 0.012). Center performance was different: noninvasive cancer rates ranged from 0% to 30% (P = 0.0581), and Sup-B from 0% to 100% (P = 0.019). Noninvasive cancer rate was < 10% in 5 centers and > 20% in 5.

Conclusions Noninvasive cancer rate among cases referred to surgery was 15%, but significantly heterogeneous among centers in superficial neoplasms not underwent ER, and deep neoplasms without invasive features (i.e. stricture or ulceration). Endoscopic characterization needs to be diffusely improved, and referral centers should interrogated before surgery and provide ESD when indicated.