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. 2023 Oct 12;4(1):e300.
doi: 10.1002/deo2.300. eCollection 2024 Apr.

Characteristics of positive horizontal margins in patients who underwent colorectal endoscopic submucosal dissection

Kazumasa Kawashima  1 , Takuto Hikichi  2 , Michio Onizawa  1 , Naohiko Gunji  1 , Yu Watahiki  1 , Chiharu Sakuma  1 , Tomoaki Mochimaru  1 , Mai Murakami  1 , Osamu Suzuki  3 , Yuko Hashimoto  3 , Masao Kobayakawa  2   4 , Hiromasa Ohira  1
Affiliations

Characteristics of positive horizontal margins in patients who underwent colorectal endoscopic submucosal dissection

Kazumasa Kawashima et al. DEN Open. .

Abstract

Objectives: Endoscopic submucosal dissection (ESD) enables en bloc resection of colorectal neoplasms, but occasionally results in positive horizontal margins (HMs). However, the site of the resected specimen that tends to be positive for HM has not been investigated. We aimed to clarify the characteristics associated with HMs in lesions resected en bloc with ESD.

Methods: Patients with colorectal neoplasms who underwent en bloc resection with ESD were included in this study. The patients were divided into negative HMs (HM0) and positive or indeterminate HMs (HM1) groups. The characteristics associated with HM1 resection were investigated. In addition, the local recurrence rate during endoscopic follow-up for >6 months after ESD was observed.

Results: In total, 201 lesions were analyzed in 189 patients (HM0, 189 lesions; HM1, 12 lesions). The HM1 group had a significantly larger median lesion diameter (25 vs. 55 mm; p < 0.001) and more lesions with >50% circumference than did the HM0 group (p < 0.001). Furthermore, the prevalence of severe fibrosis was significantly higher in the HM1 group than in the HM0 group (p < 0.001). Positive horizontal sites of the resected specimens were more frequent at the oral and anal sites than at the lateral sites. No local recurrences were observed in either group.

Conclusions: The characteristics associated with HM1 depended on lesion size, particularly lesions with >50% circumference, and submucosal fibrosis.

Keywords: colorectal neoplasm; endoscopic submucosal dissection; fibrosis; horizontal margin; lesion size.

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Conflict of interest statement

Authors declare no conflicts of interest for this article.

Figures

FIGURE 1
FIGURE 1
Flowchart of the study. ESD, endoscopic submucosal dissection; HM0, lesions with negative horizontal margins; HM1, lesions with positive or indeterminate horizontal margins; VM1, lesions with positive vertical margins.
FIGURE 2
FIGURE 2
Endoscopic images in case 1 with positive horizontal margin resection. Images under white light (a) and after spraying with indigo carmine (b). The granular‐type laterally spreading lesion with a nodular mixed type in the rectosigmoid colon occupied 75% of the circumference.
FIGURE 3
FIGURE 3
Incision line in the endoscopic submucosal dissection procedure. The incision was performed outside the lesion according to the markings.
FIGURE 4
FIGURE 4
Resected specimen in case 1 with the positive horizontal margin resection (a) The size of resected specimen is 85 × 80 mm. The sites of positive horizontal margin are on both anal and oral site, indicated by redlines. White line shows the initial section of slice, and white arrow indicates the direction of diagnosing the pathology. (b) Adenoma was present on the initial section of slices on the white line in (a).
See this image and copyright information in PMC

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