Colorectal Cancer Screening and Postpolypectomy Surveillance.

CASE SUMMARY: A healthy 52-year-old woman without any family history presents for a health maintenance appointment and opts for a fecal immunochemical test for colorectal cancer screening after reviewing her options. After a positive result, she is referred for colonoscopy. She is found to have 3 small (<10 mm) polyps that are completely resected via snare polypectomy and return as tubular adenomas on histologic examination. It is recommended that she return for repeat colonoscopy in 3 years, at which point she has a normal examination with excellent preparation by an experienced endoscopist and is given the option to return to her average-risk screening interval.

Conservative management of malignant colorectal polyps in select cases is safe in long-term follow-up: An institutional review.

BACKGROUND: Non-operative management of early-stage polypectomy-identified colorectal cancer (CRC) may be a safe alternative, but limited data exist. METHODS: We compared outcomes between adults with post-polypectomy CRC who did and did not ultimately undergo resection from 2003 to 2018. Overall (OS) and recurrence-free (RFS) survival were calculated via log rank analysis using the Mantel-Cox method and plotted on Kaplan-Meier curves with significance evaluated at P < 0.05. RESULTS: N = 78 patients were included, most commonly with rectal/rectosigmoid CRC (45%). Almost half (47%) had resections, and the remaining 41 patients (53%) underwent organ-sparing techniques. Chemoradiation was administered to 5 of these 41 patients (12%), all with rectal cancer. At median follow-up of 52 months, 5-year OS and RFS were 78% and 100% with no significant differences when compared to resection (all P > 0.1). DISCUSSION: Using evidence-based patient selection and adjuvant therapy, organ-sparing management provides equal survival when compared to resection for post-polypectomy CRC.

Early Versus Late Recurrence in Rectal Cancer: Does Timing Matter?

BACKGROUND: The definition of early recurrence (ER) in rectal cancer is unclear, and the association of ER with post-recurrence survival (PRS) is poorly described. We therefore sought to identify if time to recurrence (TTR) is associated with PRS. METHODS: We reviewed all curative-intent resections of nonmetastatic rectal cancer from 2003 to 2018 in our institutional registry within an NCI-Designated Comprehensive Cancer Center. Clinicopathologic data at diagnosis and first recurrence were collected and analyzed. ER was pre-specified at < 24 months and late recurrence (LR) at ≥ 24 months. PRS was evaluated by the Kaplan-Meier method and Cox proportional hazards modeling. RESULTS: At a median follow-up of 53 months, 61 out of 548 (11.1%) patients undergoing resection experienced recurrence. Median TTR was 14 months (IQR 10-18) with 45 of 61 patients (74%) classified as ER. There were no significant baseline differences between patients with ER and LR. Most recurrences were isolated to the liver (26%) or lung (31%), and 16% were locoregional. ER was not associated with worse PRS compared to LR (P > 0.99). On multivariable analysis, detection of recurrence via workup for symptoms, CEA > 10 ng/mL at recurrence, and site of recurrence were independently associated with PRS. CONCLUSION: ER is not associated with PRS in patients with resected rectal cancer. Symptomatic recurrences and those accompanied by CEA elevations are associated with worse PRS, while metastatic disease confined to the liver or lung is associated with improved PRS. Attention should be directed away from TTR and instead toward determining therapy for patients with treatable oligometastatic disease.

Oncologic outcomes in resected ampullary cancer: Relevance of histologic subtype and adjuvant chemotherapy.

BACKGROUND: Outcomes in ampullary cancer (AC) may differ by pathologic subtype. No guidelines exist for the administration of adjuvant therapy (AT). We sought to evaluate the effect of subtype and AT on survival. METHODS: An institutional review of patients undergoing resection for AC from 2008-17 was performed. Recurrence-free (RFS) and overall survival (OS) were assessed by Kaplan-Meier and Cox proportional hazards modeling. RESULTS: Of 53 patients, two-thirds (62%) were stage III. Histologic subtype was evenly split between intestinal and pancreatobiliary (43% and 40%). Half of patients received AT. RFS and OS were 25 (95% CI 16-32) and 41 (CI 22-60) months, respectively, without significant difference by subtype. Stage II/III disease was associated with worse OS (HR 3.7, P = 0.03), which was improved with receipt of AT (HR 0.44, P < 0.05). CONCLUSION: Stage is the primary determinant of survival in AC, which may be improved with AT.