title: Long-term outcomes after treatment for pedunculated-type T1 colorectal carcinoma: a multicenter retrospective cohort study.
abstract: BACKGROUND
  The risk for lymph node metastasis and the prognostic significance of pedunculated-type T1 colorectal carcinomas (CRCs) require further study. We aimed to assess the validity of the 2014 Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines based on long-term outcomes of pedunculated-type T1 CRCs.
  
  
  METHODS
  In this multicenter retrospective cohort study, we examined 176 patients who underwent resection endoscopically or surgically at 14 institutions between January 1990 and December 2010. Patients meeting the JSCCR curative criteria were defined as "endoscopically curable (e-curable)" and those who did not were "non-e-curable". We evaluated the prognosis of 116 patients (58 e-curable, 58 non-e-curable) who were observed for >5 years after treatment.
  
  
  RESULTS
  Overall incidence of lymph node metastasis was 5 % (4/81; 95 % confidence interval 1.4-12 %: three cases of submucosal invasion depth ≥1000 μm [stalk invasion] and lymphatic invasion, one case of head invasion and budding grade 2/3). There was no local or metastatic recurrence in the e-curable patients, but six of them died of another cause (observation period, 80 months). There was no local recurrence in the non-e-curable patients; however, distant metastasis was observed in one patient. Death due to the primary disease was not observed in non-e-curable patients, but six of them died of another cause (observation period, 72 months).
  
  
  CONCLUSIONS
  Our data support the validity of the JSCCR curative criteria for pedunculated-type T1 CRCs. Endoscopic resection cannot be considered curative for pedunculated-type T1 CRC with head invasion alone.
authors.affiliation: Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Asayama
authors.affiliation: Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan. oka4683@hiroshima-u.ac.jp.
authors.forename: Shiro
authors.initials: S
authors.lastname: Oka
authors.affiliation: Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Nagata
authors.affiliation: Department of Gastroenterology, JA Hiroshima General Hospital, Hiroshima, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Furudoi
authors.affiliation: Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Kuwai
authors.affiliation: Department of Gastroenterology, Onomichi General Hospital, Hiroshima, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Onogawa
authors.affiliation: Department of Internal Medicine, Hiroshimakinen Hospital, Hiroshima, Japan.
authors.forename: Tadamasa
authors.initials: T
authors.lastname: Tamura
authors.affiliation: Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kanao
authors.affiliation: Department of Endoscopy, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Hiraga
authors.affiliation: Department of Gastroenterology, Chugoku Rosai Hospital, Hiroshima, Japan.
authors.forename: Hideharu
authors.initials: H
authors.lastname: Okanobu
authors.affiliation: Department of Gastroenterology, Shobara Red Cross Hospital, Hiroshima, Japan.
authors.forename: Takayasu
authors.initials: T
authors.lastname: Kuwabara
authors.affiliation: Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kunihiro
authors.affiliation: Department of Gastroenterology, Miyoshi Central Hospital, Hiroshima, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Mukai
authors.affiliation: Department of Gastroenterology, Higashihiroshima Medical Center, Hiroshima, Japan.
authors.forename: Eizo
authors.initials: E
authors.lastname: Goto
authors.affiliation: Department of Health Science, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Shimamoto
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D018572:Disease-Free Survival; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Clinicopathological characteristics; Lymph node metastasis; Outcomes; Pedunculated-type T1 colorectal carcinoma