The occurrence and characteristics of endoscopically unexpected malignant degeneration in large rectal adenomas

TREND Study group

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background and Aims: Large non-pedunculated rectal polyps are most commonly resected by endoscopic mucosal resection (EMR) or transanal endoscopic microsurgery (TEM). Despite pre-procedural diagnostics, unexpected rectal cancer is incidentally encountered within the resected specimen. This study aimed to compare the diagnostic assessment and procedural characteristics of lesions with and without unexpected submucosal invasion. Methods: A post-hoc analysis of a multicenter randomized trial (TREND study) was performed in which patients with a non-pedunculated rectal polyp of ≥3 cm without endoscopic suspicion of invasive growth were randomized between EMR and TEM. Results: Unexpected rectal cancer was detected in 13% (27/203) of patients; 15 after EMR and 12 after TEM. Most consisted of low-risk T1 cancers (78%, n = 18). There were no differences in the diagnostic assessment between lesions with and without unexpected submucosal invasion. Diagnostic biopsies revealed similar rates of high-grade dysplasia (28% [7/25] vs 18% [26/144]). When compared with EMR of adenomas, EMR procedures of unexpected cancers had a lower success rate of submucosal lifting (60% vs 93%, P <.001), were more often assessed as endoscopically incomplete (33% vs 10%, P =.01), and were more frequently terminated prematurely (60% vs 8%, P =.001). Conclusions: Diagnostic assessment of large non-pedunculated rectal polyps revealed similar characteristics between unexpected cancers and adenomas. Unexpected cancers during EMR were non-lifting in 40%, endoscopically assessed as incomplete in 33%, and terminated prematurely in 60%. In treatment-naive patients, these factors should raise suspicion of malignancy and need discussion in a multidisciplinary team meeting for decision on further treatment strategies.
Original languageEnglish
Pages (from-to)688-694.e2
JournalGastrointestinal Endoscopy
Volume87
Issue number3
DOIs
Publication statusPublished - 2018
Externally publishedYes

Cite this

@article{719200390c6342259f8aa202652f609d,
title = "The occurrence and characteristics of endoscopically unexpected malignant degeneration in large rectal adenomas",
abstract = "Background and Aims: Large non-pedunculated rectal polyps are most commonly resected by endoscopic mucosal resection (EMR) or transanal endoscopic microsurgery (TEM). Despite pre-procedural diagnostics, unexpected rectal cancer is incidentally encountered within the resected specimen. This study aimed to compare the diagnostic assessment and procedural characteristics of lesions with and without unexpected submucosal invasion. Methods: A post-hoc analysis of a multicenter randomized trial (TREND study) was performed in which patients with a non-pedunculated rectal polyp of ≥3 cm without endoscopic suspicion of invasive growth were randomized between EMR and TEM. Results: Unexpected rectal cancer was detected in 13{\%} (27/203) of patients; 15 after EMR and 12 after TEM. Most consisted of low-risk T1 cancers (78{\%}, n = 18). There were no differences in the diagnostic assessment between lesions with and without unexpected submucosal invasion. Diagnostic biopsies revealed similar rates of high-grade dysplasia (28{\%} [7/25] vs 18{\%} [26/144]). When compared with EMR of adenomas, EMR procedures of unexpected cancers had a lower success rate of submucosal lifting (60{\%} vs 93{\%}, P <.001), were more often assessed as endoscopically incomplete (33{\%} vs 10{\%}, P =.01), and were more frequently terminated prematurely (60{\%} vs 8{\%}, P =.001). Conclusions: Diagnostic assessment of large non-pedunculated rectal polyps revealed similar characteristics between unexpected cancers and adenomas. Unexpected cancers during EMR were non-lifting in 40{\%}, endoscopically assessed as incomplete in 33{\%}, and terminated prematurely in 60{\%}. In treatment-naive patients, these factors should raise suspicion of malignancy and need discussion in a multidisciplinary team meeting for decision on further treatment strategies.",
author = "{TREND Study group} and Bronzwaer, {Maxime E. S.} and Musters, {Gijsbert D.} and Barendse, {Ren{\'e}e M.} and Lianne Koens and {de Graaf}, {Eelco J. R.} and Doornebosch, {Pascal G.} and Schwartz, {Matthijs P.} and Consten, {Esther C. J.} and Schoon, {Erik J.} and {de Hingh}, {Ignace H. J. T.} and Tanis, {Pieter J.} and Evelien Dekker and Paul Fockens and Bemelman, {Willem A.} and Bart Bijnen and Raf Bisschops and {van den Broek}, {Frank J. C.} and Paul Davids and Annekatrien Depla and {van Dullemen}, Hendrik and Hardwick, {James C.} and Chrisiaan Hoff and Martin Houben and Jansen, {Jeroen M.} and Gerhards, {Michael F.} and {van der Linde}, Klaas and {van Milligen de Wit}, {A. W. Marc} and Rosalie Mallant and {van der Schelling}, {George P.} and Robin Timmer and Ben Witteman and Weusten, {Bas L. A. M.} and Albert Wolthuis",
year = "2018",
doi = "10.1016/j.gie.2017.09.046",
language = "English",
volume = "87",
pages = "688--694.e2",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "3",

}

The occurrence and characteristics of endoscopically unexpected malignant degeneration in large rectal adenomas. / TREND Study group.

In: Gastrointestinal Endoscopy, Vol. 87, No. 3, 2018, p. 688-694.e2.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - The occurrence and characteristics of endoscopically unexpected malignant degeneration in large rectal adenomas

AU - TREND Study group

AU - Bronzwaer, Maxime E. S.

AU - Musters, Gijsbert D.

AU - Barendse, Renée M.

AU - Koens, Lianne

AU - de Graaf, Eelco J. R.

AU - Doornebosch, Pascal G.

AU - Schwartz, Matthijs P.

AU - Consten, Esther C. J.

AU - Schoon, Erik J.

AU - de Hingh, Ignace H. J. T.

AU - Tanis, Pieter J.

AU - Dekker, Evelien

AU - Fockens, Paul

AU - Bemelman, Willem A.

AU - Bijnen, Bart

AU - Bisschops, Raf

AU - van den Broek, Frank J. C.

AU - Davids, Paul

AU - Depla, Annekatrien

AU - van Dullemen, Hendrik

AU - Hardwick, James C.

AU - Hoff, Chrisiaan

AU - Houben, Martin

AU - Jansen, Jeroen M.

AU - Gerhards, Michael F.

AU - van der Linde, Klaas

AU - van Milligen de Wit, A. W. Marc

AU - Mallant, Rosalie

AU - van der Schelling, George P.

AU - Timmer, Robin

AU - Witteman, Ben

AU - Weusten, Bas L. A. M.

AU - Wolthuis, Albert

PY - 2018

Y1 - 2018

N2 - Background and Aims: Large non-pedunculated rectal polyps are most commonly resected by endoscopic mucosal resection (EMR) or transanal endoscopic microsurgery (TEM). Despite pre-procedural diagnostics, unexpected rectal cancer is incidentally encountered within the resected specimen. This study aimed to compare the diagnostic assessment and procedural characteristics of lesions with and without unexpected submucosal invasion. Methods: A post-hoc analysis of a multicenter randomized trial (TREND study) was performed in which patients with a non-pedunculated rectal polyp of ≥3 cm without endoscopic suspicion of invasive growth were randomized between EMR and TEM. Results: Unexpected rectal cancer was detected in 13% (27/203) of patients; 15 after EMR and 12 after TEM. Most consisted of low-risk T1 cancers (78%, n = 18). There were no differences in the diagnostic assessment between lesions with and without unexpected submucosal invasion. Diagnostic biopsies revealed similar rates of high-grade dysplasia (28% [7/25] vs 18% [26/144]). When compared with EMR of adenomas, EMR procedures of unexpected cancers had a lower success rate of submucosal lifting (60% vs 93%, P <.001), were more often assessed as endoscopically incomplete (33% vs 10%, P =.01), and were more frequently terminated prematurely (60% vs 8%, P =.001). Conclusions: Diagnostic assessment of large non-pedunculated rectal polyps revealed similar characteristics between unexpected cancers and adenomas. Unexpected cancers during EMR were non-lifting in 40%, endoscopically assessed as incomplete in 33%, and terminated prematurely in 60%. In treatment-naive patients, these factors should raise suspicion of malignancy and need discussion in a multidisciplinary team meeting for decision on further treatment strategies.

AB - Background and Aims: Large non-pedunculated rectal polyps are most commonly resected by endoscopic mucosal resection (EMR) or transanal endoscopic microsurgery (TEM). Despite pre-procedural diagnostics, unexpected rectal cancer is incidentally encountered within the resected specimen. This study aimed to compare the diagnostic assessment and procedural characteristics of lesions with and without unexpected submucosal invasion. Methods: A post-hoc analysis of a multicenter randomized trial (TREND study) was performed in which patients with a non-pedunculated rectal polyp of ≥3 cm without endoscopic suspicion of invasive growth were randomized between EMR and TEM. Results: Unexpected rectal cancer was detected in 13% (27/203) of patients; 15 after EMR and 12 after TEM. Most consisted of low-risk T1 cancers (78%, n = 18). There were no differences in the diagnostic assessment between lesions with and without unexpected submucosal invasion. Diagnostic biopsies revealed similar rates of high-grade dysplasia (28% [7/25] vs 18% [26/144]). When compared with EMR of adenomas, EMR procedures of unexpected cancers had a lower success rate of submucosal lifting (60% vs 93%, P <.001), were more often assessed as endoscopically incomplete (33% vs 10%, P =.01), and were more frequently terminated prematurely (60% vs 8%, P =.001). Conclusions: Diagnostic assessment of large non-pedunculated rectal polyps revealed similar characteristics between unexpected cancers and adenomas. Unexpected cancers during EMR were non-lifting in 40%, endoscopically assessed as incomplete in 33%, and terminated prematurely in 60%. In treatment-naive patients, these factors should raise suspicion of malignancy and need discussion in a multidisciplinary team meeting for decision on further treatment strategies.

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85036661543&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/29030001

U2 - 10.1016/j.gie.2017.09.046

DO - 10.1016/j.gie.2017.09.046

M3 - Article

VL - 87

SP - 688-694.e2

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 3

ER -