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Ileocaecal junction carcinoma: a clinicopathological study of 199 cases
Author(s) -
Lee L. H.,
MacLean A. R.,
Falck V. G.,
Gui X.
Publication year - 2015
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12760
Subject(s) - medicine , carcinoma , general surgery
Aim The ileocaecal junction ( ICJ ) region is an epithelial transition zone in which carcinomas are frequently diagnosed. However, it is currently unknown whether ICJ carcinomas ( ICJ ‐ CA s) have distinctive features. This study aimed to characterize the clinicopathological features of ICJ ‐ CA s. Method All ileal and colorectal resections for carcinoma, performed in Calgary, Canada between January 2009 and June 2012, were reviewed. Carcinomas in which the epicentre was within 5 cm of the ileocaecal valve ( ICV ) were defined as ICJ ‐ CA s. Of 1003 carcinomas studied, 199 (19.8%) were ICJ ‐ CA s, including 93 (9.3%) that crossed the ICV . Comparison of clinicopathological features with carcinomas of the other ileo‐colorectal regions was made. Survival was also assessed. Results Clinically, ICJ‐CAs were more common in female than male patients (56.3% female) compared with left‐colonic (42.9% female) and rectal (37.9% female) carcinomas, and were more common in older age‐groups of patients (71.8 ± 12.7 years) compared with appendiceal (62.6 ± 11.3 years), left‐colonic (69.4 ± 12.3 years) and rectal (67.1 ± 11.9 years) carcinomas. Macroscopically, ICJ ‐ CA s were similar to other colorectal carcinomas and were mostly described as ulcerated (63.3%). Histologically, ICJ ‐ CA s had more mucinous, signet‐ring cell and/or neuroendocrine features (39.7%, 8.0% and 7.5%, respectively) than did carcinomas of the left colon (16.8%, 1.6% and 1.1%, respectively) and the rectum (14.1%, 1.0% and 0.0%, respectively). They were higher grade (20.1% were high grade) than those of the left‐colon (10.3%) and the rectum (9.8%). ICJ ‐ CA s presented at a higher T‐stage (25.6% were T4) compared with rectal carcinomas (11.6%). Most significantly, ICJ ‐ CA s presented at a higher N‐stage (25.6% were N2) than did right‐colonic (14.1%) and rectal (16.2%) carcinomas. Although survival of patients with ICJ ‐ CA s did not differ from those with right‐colonic carcinomas, those with carcinomas directly involving the ICV did show a significantly decreased survival. Conclusion ICJ ‐ CA s display several distinct clinicopathological features that may require special diagnostic, prognostic and management attention.