Long-term clinical outcomes of endoscopic submucosal dissection for colorectal neoplasms in 423 cases: a retrospective study

Abstract

Background and study aim Endoscopic submucosal dissection (ESD) is known as a curative treatment for colorectal superficial neoplasms. There is however a need for more long-term clinical data to establish the full advantages of colorectal ESD regarding very low recurrence rates. The aim of this retrospective study was to determine long-term clinical outcomes of colorectal ESD.

Methods A total of 423 lesions treated by ESD for colorectal adenoma/dysplasia or adenocarcinoma between 1998 and 2008 at a single high volume referral center were included. We conducted a retrospective survey on patients with follow-up and obtained complete 1-, 3-, and 5-year outcome data for 358 (85 %), 292 (69 %), and 209 (49 %) lesions, respectively. Curative resection was defined when the pathological specimen had carcinoma-free resection margins, irrespective of piecemeal or en bloc resection, without submucosal deep invasion (≥ 1000 µm), lymphovascular involvement, or a poorly differentiated adenocarcinoma component.

Results After a median 4.9 years of follow-up, the 3-year overall cumulative endoscopic recurrence rate and cancerous recurrence rate were 2.9 % (95 % confidence interval [95 %CI] 1.2 – 4.7) and 1.1 % (0 – 2.1), respectively. The 5-year overall cumulative endoscopic recurrence and cancerous recurrence rates were 3.8 % (1.7 – 5.9) and 1.6 % (0.1 – 3.0), respectively. In 361 lesions eligible for endoscopic follow-up, the 3-year endoscopic recurrence and cancerous recurrence rates were 2.4 % (0.8 – 4.1) and 0.4 % (0 – 1.4), respectively. Multivariate analysis revealed that piecemeal resection and submucosal deep tumor invasion were associated with recurrence.

Conclusions The current study demonstrated favorable long-term clinical outcomes of colorectal ESD when en bloc curative resection is achieved.

• References

• 1 Zauber AG. Winawer SJ. O’Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
• 2 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
• 3 Sakamoto T. Matsuda T. Nakajima T. et al. Efficacy of endoscopic mucosal resection with circumferential incision for patients with large colorectal tumors. Clin Gastroenterol Hepatol 2012; 10: 22-26
• 4 Buchner AM. Guarner-Argente C. Ginsberg GG. Outcomes of EMR of defiant colorectal lesions directed to an endoscopy referral center. Gastrointest Endosc 2012; 76: 255-263
• 5 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
• 6 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
• 7 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
• 8 Niimi K. Fujishiro M. Kodashima S. et al. Long-term outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy 2010; 42: 723-729
• 9 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
• 10 Lee EJ. Lee JB. Lee SH. et al. Endoscopic submucosal dissection for colorectal tumors – 1,000 colorectal ESD cases: one specialized institute’s experiences. Surg Endosc 2013; 27: 31-39
• 11 Ikematsu H. Yoda Y. Matsuda T. et al. Long-term outcomes after resection for submucosal invasive colorectal cancers. Gastroenterology 2013; 144: 551-559 ; quiz e514
• 12 Yoda Y. Ikematsu H. Matsuda T. et al. A large-scale multicenter study of long-term outcomes after endoscopic resection for submucosal invasive colorectal cancer. Endoscopy 2013; 45: 718-724
• 13 Matsuda T. Fujii T. Saito Y. et al. Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms. Am J Gastroenterol 2008; 103: 2700-2706
• 14 Saito Y. Otake Y. Sakamoto T. et al. Indications for and technical aspects of colorectal endoscopic submucosal dissection. Gut Liver 2013; 7: 263-269
• 15 Saito Y. Fujii T. Kondo H. et al. Endoscopic treatment for laterally spreading tumors in the colon. Endoscopy 2001; 33: 682-686
• 16 Uraoka T. Saito Y. Matsuda T. et al. Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut 2006; 55: 1592-1597
• 17 Matsuda T. Saito Y. Nakajima T. et al. Macroscopic estimation of submucosal invasion in the colon. Tech Gastrointest Endosc 2011; 13: 24-32
• 18 Hamilton SR. Bosman FT. Boffetta P. et al. Carcinoma of the colon and rectum. In: Bosman FT. Carneiro F. Hruban RH. et al., eds. WHO classification of tumours of the digestive system. 4th. edn. Lyon: IARC; 2010: 134-142
• 19 Watanabe T. Itabashi M. Shimada Y. et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol 2012; 17: 1-29
• 20 Moss A. Williams SJ. Hourigan LF. 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
• 21 Sakamoto T. Matsuda T. Otake Y. et al. Predictive factors of local recurrence after endoscopic piecemeal mucosal resection. J Gastroenterol 2012; 47: 635-640
• 22 Moss A. Bourke MJ. Williams SJ. et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 2011; 140: 1909-1918
• 23 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
• 24 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
• 25 Sakamoto T. Saito Y. Matsuda T. et al. Treatment strategy for recurrent or residual colorectal tumors after endoscopic resection. Surg Endosc 2011; 25: 255-260
• 26 Khashab M. Eid E. Rusche M. et al. Incidence and predictors of "late" recurrences after endoscopic piecemeal resection of large sessile adenomas. Gastrointest Endosc 2009; 70: 344-349
• 27 Yamada M. Saito Y. Sakamoto T. et al. Endoscopic predictors of deep submucosal invasion in colorectal laterally spreading tumors. Endoscopy 2016; 48: 456-464
• 28 Kawachi H. Eishi Y. Ueno H. et al. A three-tier classification system based on the depth of submucosal invasion and budding/sprouting can improve the treatment strategy for T1 colorectal cancer: a retrospective multicenter study. Mod Pathol 2015; 28: 872-879
• 29 Hassan C. Quintero E. Dumonceau JM. et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2013; 45: 842-851
• 30 Kudo S. Hirota S. Nakajima T. et al. Colorectal tumours and pit pattern. J Clin Pathol 1994; 47: 880-885
• 31 Suzuki T. Hara T. Kitagawa Y. et al. Magnified endoscopic observation of early colorectal cancer by linked color imaging with crystal violet staining (with video). Gastrointest Endosc 2016;
• 32 Fu KI. Sano Y. Kato S. et al. Chromoendoscopy using indigo carmine dye spraying with magnifying observation is the most reliable method for differential diagnosis between non-neoplastic and neoplastic colorectal lesions: a prospective study. Endoscopy 2004; 36: 1089-1093
• 33 Saito Y. Sakamoto T. Nakajima T. et al. Colorectal ESD: current indications and latest technical advances. Gastrointest Endosc Clin N Am 2014; 24: 245-255
• 34 Saito Y. Yamada M. So E. et al. Colorectal endoscopic submucosal dissection: Technical advantages compared to endoscopic mucosal resection and minimally invasive surgery. Dig Endosc 2014; 26 (Suppl. 01) 52-61