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. 2018 Mar 21;38(1):3.
doi: 10.1186/s40880-018-0273-4.

Long-term outcomes of endoscopic submucosal dissection for high-grade dysplasia and early-stage carcinoma in the colorectum

Tao Chen  1 , Wen-Zheng Qin  2 , Li-Qing Yao  2 , Yun-Shi Zhong  2 , Yi-Qun Zhang  2 , Wei-Feng Chen  2 , Jian-Wei Hu  2 , Marie Ooi  2 , Ling-Li Chen  3 , Ying-Yong Hou  3 , Mei-Dong Xu  2 , Ping-Hong Zhou  4
Affiliations

Long-term outcomes of endoscopic submucosal dissection for high-grade dysplasia and early-stage carcinoma in the colorectum

Tao Chen et al. Cancer Commun (Lond). .

Abstract

Background: Colorectal carcinomas (CRCs) arise from premalignant precursors in an adenoma-carcinoma sequence, in which adenoma with high-grade dysplasia (HGD) and early-stage carcinoma are defined as advanced neoplasia. A limited number of studies have evaluated the long-term outcomes of endoscopic submucosal dissection (ESD) for advanced colorectal neoplasia. This study aimed to assess the efficacy and safety of ESD for advanced colorectal neoplasia as well as the long-term outcomes, including local recurrence and metastasis.

Methods: We analyzed data collected from 610 consecutive patients with 616 advanced colorectal neoplasia lesions treated with ESD between January 2007 and December 2013. Clinical, endoscopic, and histological data were collected over a median follow-up period of 58 months to determine tumor stage and type, resection status, complications, tumor recurrence, and distant metastasis.

Results: The overall rates of en bloc resection, histological complete resection, and major complications were 94.3%, 89.4%, and 2.3%, respectively. Hybrid ESD was an independent factor of piecemeal resection. Tumor location in the colon was associated with increased risk of ESD-related complications. During the follow-up period, all patients remained free of metastasis. However, local recurrence occurred in 4 patients (0.8%); piecemeal resection was a risk factor.

Conclusions: ESD is effective and safe for resection of advanced colorectal neoplasia, with a high en bloc resection rate and favorable long-term outcomes. ESD is indicated for the treatment of HGD and early-stage CRC to obtain curative resection and reduce local recurrence rate.

Keywords: Colorectum; Early-stage carcinoma; Endoscopic submucosal resection; High-grade dysplasia.

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Figures

Fig. 1
Fig. 1
Endoscopic submucosal dissection (ESD) of a high-grade rectal dysplasia. a Endoscopic view of the lesion; b marker dots on the normal mucosa; c mucosal incision along the marker dots; d the artificial ulcer bed after ESD; e tissue specimens fixed to a wooden plate using thin needles; f endoscopic view of the scar during follow-up period
Fig. 2
Fig. 2
Flowchart of selecting patients with high-grade dysplasia and early-stage carcinoma of the colorectum who underwent ESD
See this image and copyright information in PMC

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