Pathology Department, Ascension St. John Hospital, Detroit, MI 48236, USA.
Gastroenterology, Ascension St. John Hospital, Detroit, MI 48236, USA.
Medicina (Kaunas). 2023 Oct 11;59(10):1807. doi: 10.3390/medicina59101807.
: Full-thickness trans anal local excision for tumors with favorable response following neoadjuvant therapy for locally advanced rectal cancer (LARC) is a common strategy for organ preservation, but it could be associated with a high rate of postoperative complications. We describe the incidence and pattern of submucosal involvement in surgical specimens following neoadjuvant therapy for LARC and whether limiting local excision of the residual tumor bed to only mucosal/submucosal layers of the rectal wall is sufficient for accurately predicting the ypT status of residual cancer, providing a pathological rationale to replace full-thickness local excision by endoscopic submucosal resection. : This was a single-institution retrospective study conducted at a teaching community hospital. We reviewed clinical and pathological findings with slides of 82 patients diagnosed with LARC treated at our center between 2006 and 2020. Eligibility criteria mirrored our current organ preservation trials. : No tumor was found in surgical specimens in 28 cases (34%). Additionally, 4, 22, 27, and 1 cases were staged as ypT1, ypT2, ypT3, and ypT4, respectively. Residual malignant cells were found in the submucosal layer in 98% of cases with ypT+ stage, with 'skip lesions' in only 2% of cases. : A very high incidence of submucosal involvement is noticed in residual tumors after neoadjuvant therapy, providing pathological rationale to study the role of endoscopic submucosal resection as a restaging tool for tumors with favorable response after neoadjuvant therapy when organ preservation strategy is pursued. This study was limited by its retrospective design and relatively small number of patients.
: 对于接受新辅助治疗后局部进展期直肠癌（LARC）局部反应良好的肿瘤，全层经肛门局部切除是一种常见的保留器官策略，但可能与较高的术后并发症发生率相关。我们描述了 LARC 新辅助治疗后手术标本中黏膜下受累的发生率和模式，以及是否仅将残余肿瘤床的局部切除限制在直肠壁的黏膜/黏膜下层，以准确预测残留癌的 ypT 状态，为用内镜黏膜下切除术替代全层局部切除术提供病理依据。 : 这是一项在教学社区医院进行的单中心回顾性研究。我们回顾了 2006 年至 2020 年在我们中心治疗的 82 例 LARC 患者的临床和病理发现以及幻灯片。入选标准反映了我们目前的器官保留试验。 : 在 28 例（34%）手术标本中未发现肿瘤。此外，分别有 4、22、27 和 1 例分期为 ypT1、ypT2、ypT3 和 ypT4。ypT+ 期病例中 98%的病例在黏膜下层发现残留恶性细胞，仅有 2%的病例存在“跳跃性病变”。 : 新辅助治疗后残余肿瘤中注意到黏膜下受累的发生率非常高，为研究内镜黏膜下切除术在追求器官保留策略时作为新辅助治疗后反应良好的肿瘤的再分期工具的作用提供了病理依据。本研究受到回顾性设计和患者数量相对较少的限制。
