Review of incomplete macroscopic resections(R2)in rectal cancer:Treatment,prognosis and future perspectives

Colorectal cancer is one of the most prevalent tumours,but with improved treatment and early detection,its prognosis has greatly improved in recent years.However,when the tumour is locally advanced at diagnosis or if there is local recurrence,it is more difficult to perform a complete tumour resection,and there may be a residual macroscopic tumour.In this paper,we review the literature on residual macroscopic tumour resections,concerning both locally advanced primary tumours and recurrences,evaluating the main problems encountered,the treatments applied,the prognosis and future perspectives in this field.

Risk factors for incomplete polyp resection during colonoscopy

Colonoscopic polypectomy is extremely effective in protecting against colorectal cancers,and recognition of adenomas by colonoscopy is of paramount importance in preventing colorectal cancer(CRC)and CRC-associated mortality.Incomplete polyp resection(IPR)occurs routinely in medical practice following polypectomy.We conducted a comprehensive literature search to identify studies that reported on the potential risk factors for IPR using MEDLINE,EMBASE,and PubMed.Publication time was limited between January 2004 and July 2021.Our search revealed assessments of the position,morphology,and histologic variation of the polypsdas well as the relevant skills that may interfere with IPR.The included studies showed that colonic polyps with a diameter>20 mm and proximal in location should be dealt with cautiously.For smaller polyps,cold-snare polypectomy appeared to be the most effective method used to accomplish comprehensive polyp removal.In addition,endoscopist experience in narrow-band imaging in polyp detection were also associated with IPR.Therefore,polypectomy should be performed cautiously if the polyp growth is expected to be cancerous and situated in the proximal portion of the colon or rectum,and modalities should be standardized so as to lower the potential risk for IPR.

Risk factors and clinical outcomes of incomplete endoscopic resection of small rectal neuroendocrine tumors in southern China:a 9-year data analysis

Background:The histologically complete resection(CR)rate of small rectal neuroendocrine tumors(RNETs)is unsatisfactory at the first endoscopy.Risk factors and clinical outcomes associated with incomplete resection(IR)have not been explicitly elucidated.This study aims to explore the relevant factors of IR.Methods:This retrospective study reviewed patients with small RNETs(10mm)in eight centers from January 2013 to December 2021.Clinicopathological characteristics and clinical outcomes were compared between the CR and IR groups,and the polypectomy and advanced treatment groups.Results:Of the 326 patients included,83(25.5%)were diagnosed with IR.Polypectomy(odds ratio[OR]=16.86),a central depression(OR=7.50),and treatment in the early period(OR=2.60)were closely associated with IR.Further analysis revealed that an atypical hyperemic appearance(OR=7.49)and treatment in the early period(OR=2.54)were significantly associated with the inappropriate use of polypectomy(both P<0.05).In addition,a total of 265(81.3%)were followed up with a median follow-up period of 30.9 months.No death,metastasis,or recurrence was found during the follow-up period.Conclusions:Polypectomy,a central depression,and treatment in the early period were risk factors for IR.Further,an atypical hyperemic appearance and treatment in the early period were significant predisposing factors for inappropriate choice of polypectomy.For histologically incompletely resected small RNETs,follow-up may be a safe and feasible alternative to rigorous salvage therapy.