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Long-term outcomes after endoscopic submucosal dissection for superficial colorectal tumors

      Background and Aims

      Endoscopic submucosal dissection (ESD) is an effective procedure for en bloc resection of superficial colorectal tumors regardless of tumor size or location. However, there are few reports on long-term outcomes for patients with superficial colorectal tumors after ESD. We therefore aimed to evaluate the long-term outcomes after ESD for superficial colorectal tumors.

      Methods

      ESD was performed on 257 colorectal tumors in 255 consecutive patients at Hiroshima University Hospital between June 2003 and July 2010. We investigated the following variables: patient characteristics, the American Society of Anesthesiologists score, tumor location, tumor size, growth type, histology, en bloc resection rate, achievement of curative resection, procedure time, and adverse events. The 5-year overall survival (OS), 5-year disease-specific survival (DSS), local recurrence, and metachronous tumor occurrence were also analyzed.

      Results

      We identified 224 tumors in 222 patients who were confirmed dead or had follow-up data for more than 5 years. After a median follow-up of 79 months, 5-year OS and DSS rates were 94.6% and 100%, respectively. The local recurrence rate (1.5%) was significantly higher in patients undergoing piecemeal resection (9.1%) compared with en bloc resection (0.6%), in cases of histologic incomplete resection compared with complete resection, and in cases of non-R0 resection compared with R0 resection. The rates of total number of tumors (≥6 mm) and carcinoma metachronous tumors after ESD without additional surgical resection were 18.9% (38/201) and 4.0% (8/201), respectively.

      Conclusions

      Long-term outcomes after ESD for superficial colorectal tumors are favorable. Patients should be surveyed for both local recurrence and metachronous tumors after ESD.

      Abbreviations:

      ASA (American Society of Anesthesiologists), DSS (disease-specific survival), ESD (endoscopic submucosal dissection), HMO (horizontal margin negative), JSCCR (Japanese Society for Cancer of the Colon and Rectum), LST (laterally spreading tumor), OS (overall survival), SD (standard deviation), SM (submucosal), VMO (vertical margin negative)
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      References

        • Saito Y.
        • Fukuzawa M.
        • Matsuda T.
        • et al.
        Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection.
        Surg Endosc. 2010; 24: 343-352
        • Tanaka S.
        • Oka S.
        • Chayama K.
        Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection.
        J Gastroenterol. 2008; 43: 641-651
        • Terasaki M.
        • Tanaka S.
        • Oka S.
        • et al.
        Clinical outcomes of endoscopic submucosal dissection and endoscopic mucosal resection for laterally spreading tumors larger than 20 mm.
        J Gastroenterol Hepatol. 2012; 27: 734-740
        • Tanaka S.
        • Tamegai Y.
        • Tsuda S.
        • et al.
        Multicenter questionnaire survey on the current situation of colorectal endoscopic submucosal dissection in Japan.
        Dig Endosc. 2010; 22: S2-S8
        • Tanaka S.
        • Oka S.
        • Kaneko I.
        • et al.
        Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization.
        Gastrointest Endosc. 2007; 66: 100-107
        • Tamegai Y.
        • Saito Y.
        • Masaki N.
        • et al.
        Endoscopic submucosal dissection: a safe technique for colorectal tumors.
        Endoscopy. 2007; 39: 418-422
        • Hurlstone D.P.
        • Atkinson R.
        • Sanders D.S.
        • et al.
        Achieving R0 resection in the colorectum using endoscopic submucosal dissection.
        Br J Surg. 2007; 94: 1536-1542
        • Fujishiro M.
        • Yahagi N.
        • Kakushima N.
        • et al.
        Outcome of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases.
        Clin Gastroenterol Hepatol. 2007; 5: 678-683
        • Zhou P.H.
        • Yao L.Q.
        • Qin X.Y.
        Endoscopic submucosal dissection for colorectal epithelial neoplasm.
        Surg Endosc. 2009; 23: 1546-1551
        • Isomoto H.
        • Nishiyama H.
        • Yamaguchi N.
        • et al.
        Clinicopathological factors associated with clinical outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms.
        Endoscopy. 2009; 41: 679-683
        • Matsumoto A.
        • Tanaka S.
        • Oba S.
        • et al.
        Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis.
        Scand J Gastroenterol. 2010; 45: 1329-1337
        • Nakajima T.
        • Saito Y.
        • Tanaka S.
        • et al.
        Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan.
        Surg Endosc. 2013; 27: 3262-3270
        • Saito Y.
        • Uraoka T.
        • Yamaguchi Y.
        • et al.
        A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video).
        Gastrointest Endosc. 2010; 72: 1217-1225
      1. Tamaru Y, Oka S, Tanaka S, et al. Endoscopic submucosal dissection for anorectal tumor with hemorrhoids close to the dentate line: a multicenter study of Hiroshima GI Endoscopy Study Group. Surg Endosc. Epub 2016 Feb 19.

        • Tanaka S.
        • Terasaki M.
        • Hayashi N.
        • et al.
        Warning for unprincipled colorectal endoscopic submucosal dissection: accurate diagnosis and reasonable treatment strategy.
        Dig Endosc. 2013; 25: 107-116
        • Taku K.
        • Sano Y.
        • Fu K.l.
        • et al.
        Iatrogenic perforation associated with therapeutic colonoscopy: a multicenter study in Japan.
        J Gastroenterol Hepatol. 2007; 22: 1409-1414
        • Oka S.
        • Tanaka S.
        • Kanao H.
        • et al.
        Current status in the occurrence of postoperative bleeding, perforation and residual/local recurrence during colonoscopic treatment in Japan.
        Dig Endosc. 2010; 22: 376-380
        • Hayashi N.
        • Tanaka S.
        • Nishiyama S.
        • et al.
        Predictors of incomplete resection and perforation associated with endoscopic submucosal dissection for colorectal tumors.
        Gastrointest Endosc. 2014; 79: 427-435
        • Imai K.
        • Hotta K.
        • Yamaguchi Y.
        • et al.
        Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training.
        Gastrointest Endosc. 2016; 83: 954-962
        • Mizushima T.
        • Kato M.
        • Iwanaga I.
        • et al.
        Technical difficulty according to location, and risk factors for perforation, in endoscopic submucosal dissection of colorectal tumors.
        Surg Endosc. 2015; 29: 133-139
        • Sato K.
        • Ito S.
        • Kitagawa T.
        • et al.
        Factors affecting the technical difficulty and clinical outcome of endoscopic submucosal dissection for colorectal tumors.
        Surg Endosc. 2014; 28: 2959-2965
        • Takeuchi Y.
        • Iishi H.
        • Tanaka S.
        • et al.
        Factors associated with technical difficulties and adverse events of colorectal endoscopic submucosal dissection: retrospective exploratory factor analysis of a multicenter prospective cohort.
        Int J Colorectal Dis. 2014; 29: 1275-1284
        • Ohata K.
        • Ito T.
        • Chiba H.
        • et al.
        Effective training system in colorectal endoscopic submucosal dissection.
        Dig Endosc. 2012; 24: 84-89
        • Repici A.
        • Hassan C.
        • De Paula Pessoa D.
        • et al.
        Efficacy and safety of endoscopic submucosal dissection for colorectal neoplasia: a systematic review.
        Endoscopy. 2012; 44: 137-150
        • Patel N.
        • Patel K.
        • Ashrafian H.
        • et al.
        Colorectal endoscopic submucosal dissection: a systematic review of mid-term clinical outcomes.
        Dig Endosc. 2016; 28: 405-416
        • Niimi K.
        • Fujishiro M.
        • Kodashima S.
        • et al.
        Long-term outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms.
        Endoscopy. 2010; 42: 723-729
        • Probst A.
        • Golger D.
        • Anthuber M.
        • et al.
        Endoscopic submucosal dissection in large sessile lesions of the rectosigmoid: learning curve in a European center.
        Endoscopy. 2012; 44: 660-667
        • Lee E.J.
        • Lee J.B.
        • Lee S.H.
        • et al.
        Endoscopic submucosal dissection for colorectal tumors–1,000 colorectal ESD cases: one specialized institute's experiences.
        Surg Endosc. 2013; 27: 31-39
        • Tanaka S.
        • Kashida H.
        • Saito Y.
        • et al.
        JGES guideline for colorectal endoscopic submucosal dissection/endoscopic mucosal resection guidelines.
        Dig Endosc. 2015; 27: 417-434
        • Tanaka S.
        • Saitoh Y.
        • Matsuda T.
        • et al.
        Evidence-based clinical practice guidelines for management of colorectal polyps.
        J Gastroenterol. 2015; 50: 252-260
        • Watanabe T.
        • Itabashi M.
        • Shimada Y.
        • et al.
        Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer.
        Int J Clin Oncol. 2015; 20: 207-239
      2. Boman F.T. Carneiro F. Hruban R.H. WHO Classification of Tumours of the Digestive System. 4th ed. IARC, Lyon, France2010: 134-146
        • Japanese Society for Cancer of the Colon and Rectum (JSCCR)
        Japanese Classification of Colorectal Carcinoma.
        6th ed. Kanehara, Tokyo, Japan1998
        • Japanese Society for Cancer of the Colon and Rectum (JSCCR)
        JSCCR Guidelines for the Treatment of Colorectal Carcinoma.
        Kanehara, Tokyo, Japan2005
        • Japanese Society for Cancer of the Colon and Rectum (JSCCR)
        JSCCR Guidelines for the Treatment of Colorectal Carcinoma.
        Kanehara, Tokyo, Japan2009
        • Tajiri H.
        • Kitano S.
        Complication associated with endoscopic mucosal resection: definition of bleeding that can be viewed as accidental.
        Dig Endosc. 2004; 16: 134-136
        • Nakadoi K.
        • Tanaka S.
        • Kanao H.
        • et al.
        Management of T1 colorectal carcinoma with special reference to criteria for curative endoscopic resection.
        J Gastroenterol Hepatol. 2012; 27: 1057-1062
        • Yoshii S.
        • Nojima M.
        • Nosho K.
        • et al.
        Factors associated with risk for colorectal cancer recurrence after endoscopic resection of t1 tumors.
        Clin Gastroenterol Hepatol. 2014; 12: 292-302
        • Asayama N.
        • Oka S.
        • Tanaka S.
        • et al.
        Endoscopic submucosal dissection as total excisional biopsy for clinical T1 colorectal carcinoma.
        Digestion. 2015; 91: 64-69
        • Oka S.
        • Tanaka S.
        • Saito Y.
        • et al.
        Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan.
        Am J Gastroenterol. 2015; 110: 697-707
        • Moss A.
        • Williams S.J.
        • Hourigan L.F.
        • et al.
        Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study.
        Gut. 2015; 64: 57-65
        • Martínez M.E.
        • Baron J.A.
        • Lieberman D.A.
        • et al.
        A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy.
        Gastroenterology. 2009; 136: 832-841
        • Lieberman D.A.
        • Rex D.K.
        • Winawer S.J.
        • et al.
        Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer.
        Gastroenterology. 2012; 143: 844-857
        • Minozzi S.
        • Armaroli P.
        • Segnan N.
        European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition–Principles of evidence assessment and methods for reaching recommendations.
        Endoscopy. 2012; 44: SE9-SE14