Intest Res.  2016 Jul;14(3):270-279. 10.5217/ir.2016.14.3.270.

Characteristics and outcomes of endoscopically resected colorectal cancers that arose from sessile serrated adenomas and traditional serrated adenomas

• Seo JY
• Choi SH
• Chun J
• Lee C
• Choi JM
• Jin EH
• Hwang SW
• Im JP
• Kim SG
• Kim JS

• KMID: 2354970
• DOI: http://doi.org/10.5217/ir.2016.14.3.270

Abstract

BACKGROUND/AIMS
The efficacy and safety of endoscopic resection of colorectal cancer derived from sessile serrated adenomas or traditional serrated adenomas are still unknown. The aims of this study were to verify the characteristics and outcomes of endoscopically resected early colorectal cancers developed from serrated polyps.
METHODS
Among patients who received endoscopic resection of early colorectal cancers from 2008 to 2011, cancers with documented pre-existing lesions were included. They were classified as adenoma, sessile serrated adenoma, or traditional serrated adenoma according to the baseline lesions. Clinical characteristics, pathologic diagnosis, and outcomes were reviewed.
RESULTS
Overall, 208 colorectal cancers detected from 198 patients were included: 198 with adenoma, five with sessile serrated adenoma, and five with traditional serrated adenoma. The sessile serrated adenoma group had a higher prevalence of high-grade dysplasia (40.0% vs. 25.8%, P<0.001) than the adenoma group. During follow-up, local recurrence did not occur after endoscopic resection of early colorectal cancers developed from serrated polyps. In contrast, two cases of metachronous recurrence were detected within a short follow-up period.
CONCLUSIONS
Cautious observation and early endoscopic resection are recommended when colorectal cancer from serrated polyp is suspected. Colorectal cancers from serrated polyp can be treated successfully with endoscopy.

Keyword

Colorectal neoplasms; Colonoscopy; Colonic polyps; Sessile serrated adenoma; Traditional serrated adenoma

MeSH Terms

Adenoma*
Colonic Polyps
Colonoscopy
Colorectal Neoplasms*
Diagnosis
Endoscopy
Follow-Up Studies
Humans
Polyps
Prevalence
Recurrence

Figure

• 

  Fig. 1 Colonoscopic and histologic pictures of polyps in patient 1. (A) PET-CT image shows signal intensity in the mid transverse colon (arrow). (B) Colonoscopic features of colorectal cancer (CRC) developed from sessile serrated adenoma (SSA). (C) Histologic features of CRC (white circle) developed from SSA (black circle) (H&E, ×100).

Reference

1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012; 62:10–29. PMID: 22237781.

2. Park HC, Shin A, Kim BW, et al. Data on the characteristics and the survival of Korean patients with colorectal cancer from the Korea central cancer registry. Ann Coloproctol. 2013; 29:144–149. PMID: 24032114.

3. Burt RW. Colon cancer screening. Gastroenterology. 2000; 119:837–853. PMID: 10982778.

4. Zauber AG, Winawer SJ, O'Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012; 366:687–696. PMID: 22356322.

5. Gupta AK, Melton LJ 3rd, Petersen GM, et al. Changing trends in the incidence, stage, survival, and screen-detection of colorectal cancer: a population-based study. Clin Gastroenterol Hepatol. 2005; 3:150–158. PMID: 15704049.

6. Farrar WD, Sawhney MS, Nelson DB, Lederle FA, Bond JH. Colorectal cancers found after a complete colonoscopy. Clin Gastroenterol Hepatol. 2006; 4:1259–1264. PMID: 16996804.

7. Lieberman DA, Holub J, Eisen G, Kraemer D, Morris CD. Utilization of colonoscopy in the United States: results from a national consortium. Gastrointest Endosc. 2005; 62:875–883. PMID: 16301030.

8. Leggett B, Whitehall V. Role of the serrated pathway in colorectal cancer pathogenesis. Gastroenterology. 2010; 138:2088–2100. PMID: 20420948.

9. Terdiman JP, McQuaid KR. Surveillance guidelines should be updated to recognize the importance of serrated polyps. Gastroenterology. 2010; 139:1444–1447. PMID: 20875785.

10. Rex DK, Ahnen DJ, Baron JA, et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol. 2012; 107:1315–1329. PMID: 22710576.

11. Snover DC. Update on the serrated pathway to colorectal carcinoma. Hum Pathol. 2011; 42:1–10. PMID: 20869746.

12. Sweetser S, Smyrk TC, Sinicrope FA. Serrated colon polyps as precursors to colorectal cancer. Clin Gastroenterol Hepatol. 2013; 11:760–767. PMID: 23267866.

13. Goldstein NS. Small colonic microsatellite unstable adenocarcinomas and high-grade epithelial dysplasias in sessile serrated adenoma polypectomy specimens: a study of eight cases. Am J Clin Pathol. 2006; 125:132–145. PMID: 16483002.

14. Xu S, Wang L, Yang G, et al. Clinicopathological observations of colorectal serrated lesions associated with invasive carcinoma and high-grade intraepithelial neoplasm. Exp Ther Med. 2013; 6:1113–1120. PMID: 24223631.

15. Ban S, Mitomi H, Horiguchi H, Sato H, Shimizu M. Adenocarcinoma arising in small sessile serrated adenoma/polyp (SSA/P) of the colon: clinicopathological study of eight lesions. Pathol Int. 2014; 64:123–132. PMID: 24698422.

16. Kudo S, Kashida H, Tamura T, et al. Colonoscopic diagnosis and management of nonpolypoid early colorectal cancer. World J Surg. 2000; 24:1081–1090. PMID: 11036286.

17. Seo JY, Chun J, Lee C, et al. Novel risk stratification for recurrence after endoscopic resection of advanced colorectal adenoma. Gastrointest Endosc. 2015; 81:655–664. PMID: 25500328.

18. Bettington M, Walker N, Clouston A, Brown I, Leggett B, Whitehall V. The serrated pathway to colorectal carcinoma: current concepts and challenges. Histopathology. 2013; 62:367–386. PMID: 23339363.

19. Coindre JM. New WHO classification of tumours of soft tissue and bone. Ann Pathol. 2012; 32(5 Suppl):S115–S116. PMID: 23127926.

20. Torlakovic E, Skovlund E, Snover DC, Torlakovic G, Nesland JM. Morphologic reappraisal of serrated colorectal polyps. Am J Surg Pathol. 2003; 27:65–81. PMID: 12502929.

21. Choi JM, Lee C, Park JH, et al. Complete resection of colorectal adenomas: what are the important factors in fellow training? Dig Dis Sci. 2015; 60:1579–1588. PMID: 25540087.

22. Lieberman DA, Weiss DG, Harford WV, et al. Five-year colon surveillance after screening colonoscopy. Gastroenterology. 2007; 133:1077–1085. PMID: 17698067.

23. Martínez ME, Baron JA, Lieberman DA, et al. A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy. Gastroenterology. 2009; 136:832–841. PMID: 19171141.

24. Hiraoka S, Kato J, Fujiki S, et al. The presence of large serrated polyps increases risk for colorectal cancer. Gastroenterology. 2010; 139:1503–1510. PMID: 20643134.

25. Lu FI, van Niekerk de W, Owen D, Tha SP, Turbin DA, Webber DL. Longitudinal outcome study of sessile serrated adenomas of the colorectum: an increased risk for subsequent right-sided colorectal carcinoma. Am J Surg Pathol. 2010; 34:927–934. PMID: 20551824.

26. Teriaky A, Driman DK, Chande N. Outcomes of a 5-year follow-up of patients with sessile serrated adenomas. Scand J Gastroenterol. 2012; 47:178–183. PMID: 22229626.

27. Rustagi T, Rangasamy P, Myers M, et al. Sessile serrated adenomas in the proximal colon are likely to be flat, large and occur in smokers. World J Gastroenterol. 2013; 19:5271–5277. PMID: 23983429.

28. Dik VK, Moons LM, Siersema PD. Endoscopic innovations to increase the adenoma detection rate during colonoscopy. World J Gastroenterol. 2014; 20:2200–2211. PMID: 24605019.

29. Aust DE, Baretton GB. Members of the Working Group GI-Pathology of the German Society of Pathology. Serrated polyps of the colon and rectum (hyperplastic polyps, sessile serrated adenomas, traditional serrated adenomas, and mixed polyps)-proposal for diagnostic criteria. Virchows Arch. 2010; 457:291–297. PMID: 20617338.

30. Lee C, Koh SJ, Kim JW, et al. Incidental colonic 18F-fluorodeoxyglucose uptake: do we need colonoscopy for patients with focal uptake confined to the left-sided colon? Dig Dis Sci. 2013; 58:229–235. PMID: 22886593.