LONG-TERM OUTCOMES AFTER “NON-CURATIVE” ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) FOR COLORECTAL ADENOCARCINOMA

Aims Endoscopic-submucosal-dissection(ESD)is a well-established technique for the management of early colorectal cancer(CRC).The advantage of ESD over endoscopic-mucosal-resection is related to the achievement of en-bloc/R0resection.After ESD,patients with positive resected margins(R1),deep submucosal involvement(>sm2)poor differentiation(G3),presence of neoplastic budding(B+)and lympho-vascular invasion(LV+)at histology are considered candidate for surgery(non-curative,NC-ESD) because of the significant risk of nodal involvement.Outcomes following NC-ESDs have never been assessed in the field of CR cancer,resulting in variable clinical management.The aim of our study is to report long-term outcomes after NC-ESD,regardless of post-endoscopic management.

Methods  A retrospective analysis of a prospectively maintained database was conducted on patients treated by ESD for CRC from2011.Lesions without any of the poor prognostic stigmata(R1,G3,>sm2,B+,LV+)were considered as curatively resected and were excluded.Patients with NC-ESD were referred for additional surgical treatment.Then,they either underwent surgery with curative intent or did not, according to patient’s choice and/or inability to undergo surgery because of severe comorbidities. Outcomes of interest were overall survival(OS),cancer-specific survival(CS) and disease-free survival(DS)rates after NC- ESD.Rates of local residual disease(LR) and nodal involvement rates among patients who underwent surgery were also assessed.

Results Over the study period,46patients treated with ESDs for CRC resulted in NCresections. 31(11/20,F/M;mean age:67.7±10.6)underwent surgery. In the remaining group of patients(5/10,F/M;mean age:72.2±11.3)reason for not undergoing surgery was patient’s refusal in 6and high risk conditions due to comorbities in9.In the surgical group four patients(12.9%)had nodal metastasis with no evidence of local disease.Over a follow-up period of 38.1±24.1months one death(unrelated to cancer)was reported with 96.8% and 100% of OS and CS rates, respectively. There were 2 cases of recurrence(both as hepatic mets)in a mean follow up of 38.4±17.5months(DS rate:6.5%).One case of local recurrence was reported(DS rate:6.7%) in a mean follow up of.No deaths occurred(100% of OSandCS rates).

Conclusions Patients withNC-ESD have a low risk of LR and nodes involvement after surgery.Follow-up strategy is an option for patients with high surgical risk.