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DOI: 10.1055/s-0040-1704257
NEED FOR COLORECTAL SURGERY IN EPITELIAL LESIONS RESECTED BY ENDOSCOPIC SUBMUCOSAL DISSECTION. RESULTS FROM A SPANISH MULTICENTER COHORT
Publikationsverlauf
Publikationsdatum:
23. April 2020 (online)
Aims To evaluate the necessity for surgery after colorectal ESD. To compare the need for surgery between en bloc ESD and piecemeal-hybrid ESD, and to analyze other possible factors related.
Methods Prospective, multicenter study from Spain, including all patients with planned ESD between January 2016 and April 2019.In cases where ESD was not feasible, it was aborted or switched to en bloc/piecemeal hybrid ESD. The necessity for surgery was evaluated due to the following causes:technical difficulty,immediate complication,differed complication(1-30days) or non curative histology. Univariate analysis was carried out.
Results 930 patients were included. Endoscopic resection was completed in 886 cases(95,3%),759 en bloc(81,6%) and 127 piecemeal(13,6%).44 procedures were aborted (4,7%). In total surgery was carried out in 84 cases(9,1%).The reason for the surgery was:
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44 aborted procedures:35 due to technical difficulties and 9 to immediate perforation
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40 surgeries after completed ESD:17(1,9%) due to differed complication and 23(2,5%) to non curative histology
Among these 40 lesions:31/759(4,1%)were resected en bloc compared to 9/127(7,1%) piecemeal resections(p=0,13)
Among the 17 patients that required surgery due to differed complication, the univariate analysis showed significant differences(when compared to lesions that did not need surgery) regarding duration of the procedure (170, 2min vs 123,8min,p=0,02), size of the lesion(50,8mmvs 41,1mm,p=0,02) and type of resection (1,4% en bloc vs 4,7% piecemeal, p=0,01)
From the 23 lesions operated due to non curative histology, univariate analysis showed significant differences regarding morphology(9,5% NG- PD LST vs 1,7% others, p=0,001)and location(5,5% left colon vs 1,1% others,p=0,002). No differences were found regarding type of resection(2,6%en bloc vs 2,4% piecemeal, p=0,8).
Conclusions The global rate of surgery after ESD was 9,1%. Piecemeal hybrid EDS was significantly associated to a higher rate of surgery due to differed complication whereas no significant differences were found in global rate of surgery or surgery due to non curative histology regarding the type of technique.
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