Shiro Oka1, Shinji Tanaka1, Yutaka Saito2, Hiroyasu Iishi3, Shin-ei Kudo4, Hiroaki Ikematsu5, Masahiro Igarashi6, Yusuke Saitoh7, Yuji Inoue8, Kiyonori Kobayashi9, Takashi Hisabe10, Osamu Tsuruta11, Yasushi Sano12, Hiroo Yamano13, Seiji Shimizu14, Naohisa Yahagi15, Toshiaki Watanabe16, Hisashi Nakamura17, Takahiro Fujii18, Hideki Ishikawa19, Kenichi Sugihara20. 1. Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan. 2. Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan. 3. Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. 4. Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan. 5. Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan. 6. Department of Endoscopy, Cancer Institute Ariake Hospital, Tokyo, Japan. 7. Digestive Disease Center, Asahikawa City Hospital, Hokkaido, Japan. 8. Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 9. Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Kanagawa, Japan. 10. Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan. 11. Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan. 12. Gastrointestinal Center, Sano Hospital, Hyogo, Japan. 13. Department of Gastroenterology, Akita Red Cross Hospital, Akita, Japan. 14. Department of Gastroenterology, JR West Osaka Railway Hospital, Osaka, Japan. 15. Department of Gastroenterology, Toranomon Hospital and Cancer Center, Keio University, Tokyo, Japan. 16. Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan. 17. Department of Gastroenterology, Chofu Surgical Clinic, Tokyo, Japan. 18. Gastroenterology, Takahiro Fujii Clinic, Tokyo, Japan. 19. Department of Molecular-Targeting Cancer Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. 20. Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
Abstract
OBJECTIVES: Conventional endoscopic resection (CER) is a widely accepted treatment for early colorectal neoplasia; however, large colorectal neoplasias remain problematic, as they necessitate piecemeal resection, increasing the risk of local recurrence. Endoscopic submucosal dissection (ESD) can improve the en bloc resection rate. This study aimed to evaluate local recurrence and its associated risk factors after endoscopic resection (ER) for colorectal neoplasias ≥20 mm. METHODS: A multicenter prospective study at 18 medium- and high-volume specialized institutions was conducted in Japan. Follow-up colonoscopy was performed after 12 months in cases of complete resection and after 3-6 months in cases of incomplete resection. Local recurrence was confirmed by endoscopic findings and/or pathological analysis. RESULTS: Follow-up colonoscopy was performed in 1,524 of 1,845 enrolled colorectal neoplasias (mean age, 65 years; 885 men; median tumor size, 32.8 mm). The local recurrence rates were 4.3% (65/1,524), 6.8% (55/808), and 1.4% (10/716) for the entire cohort, for CER, and for ESD, respectively. The relative risks of local recurrence were 0.21 (95% confidence interval, 0.11-0.39) with ESD compared with CER, 0.32 (95% confidence interval, 0.11-0.92) with en bloc ESD compared with en bloc CER, and 0.90 (95% confidence interval, 0.39-2.12) with piecemeal ESD compared with piecemeal CER. Significant factors associated with local recurrence were piecemeal resection, laterally spreading tumors of granular type, tumor size ≥40 mm, no pre-treatment magnification, and ≤10 years of experience in CER, and piecemeal resection only in ESD. CONCLUSIONS: En bloc ESD reduces the local recurrence rate for large colorectal neoplasias. Piecemeal resection is the most important risk factor for local recurrence regardless of the ER method used.
OBJECTIVES: Conventional endoscopic resection (CER) is a widely accepted treatment for early colorectal neoplasia; however, large colorectal neoplasias remain problematic, as they necessitate piecemeal resection, increasing the risk of local recurrence. Endoscopic submucosal dissection (ESD) can improve the en bloc resection rate. This study aimed to evaluate local recurrence and its associated risk factors after endoscopic resection (ER) for colorectal neoplasias ≥20 mm. METHODS: A multicenter prospective study at 18 medium- and high-volume specialized institutions was conducted in Japan. Follow-up colonoscopy was performed after 12 months in cases of complete resection and after 3-6 months in cases of incomplete resection. Local recurrence was confirmed by endoscopic findings and/or pathological analysis. RESULTS: Follow-up colonoscopy was performed in 1,524 of 1,845 enrolled colorectal neoplasias (mean age, 65 years; 885 men; median tumor size, 32.8 mm). The local recurrence rates were 4.3% (65/1,524), 6.8% (55/808), and 1.4% (10/716) for the entire cohort, for CER, and for ESD, respectively. The relative risks of local recurrence were 0.21 (95% confidence interval, 0.11-0.39) with ESD compared with CER, 0.32 (95% confidence interval, 0.11-0.92) with en bloc ESD compared with en bloc CER, and 0.90 (95% confidence interval, 0.39-2.12) with piecemeal ESD compared with piecemeal CER. Significant factors associated with local recurrence were piecemeal resection, laterally spreading tumors of granular type, tumor size ≥40 mm, no pre-treatment magnification, and ≤10 years of experience in CER, and piecemeal resection only in ESD. CONCLUSIONS: En bloc ESD reduces the local recurrence rate for large colorectal neoplasias. Piecemeal resection is the most important risk factor for local recurrence regardless of the ER method used.
Authors: R J Schlemper; R H Riddell; Y Kato; F Borchard; H S Cooper; S M Dawsey; M F Dixon; C M Fenoglio-Preiser; J F Fléjou; K Geboes; T Hattori; T Hirota; M Itabashi; M Iwafuchi; A Iwashita; Y I Kim; T Kirchner; M Klimpfinger; M Koike; G Y Lauwers; K J Lewin; G Oberhuber; F Offner; A B Price; C A Rubio; M Shimizu; T Shimoda; P Sipponen; E Solcia; M Stolte; H Watanabe; H Yamabe Journal: Gut Date: 2000-08 Impact factor: 23.059
Authors: S Tanaka; K Haruma; S Oka; R Takahashi; M Kunihiro; Y Kitadai; M Yoshihara; F Shimamoto; K Chayama Journal: Gastrointest Endosc Date: 2001-07 Impact factor: 9.427
Authors: Sidney J Winawer; Ann G Zauber; Robert H Fletcher; Jonathon S Stillman; Michael J O'Brien; Bernard Levin; Robert A Smith; David A Lieberman; Randall W Burt; Theodore R Levin; John H Bond; Durado Brooks; Tim Byers; Neil Hyman; Lynne Kirk; Alan Thorson; Clifford Simmang; David Johnson; Douglas K Rex Journal: Gastroenterology Date: 2006-05 Impact factor: 22.682
Authors: Alan Moss; Michael J Bourke; Stephen J Williams; Luke F Hourigan; Gregor Brown; William Tam; Rajvinder Singh; Simon Zanati; Robert Y Chen; Karen Byth Journal: Gastroenterology Date: 2011-03-08 Impact factor: 22.682
Authors: H Isomoto; H Nishiyama; N Yamaguchi; E Fukuda; H Ishii; K Ikeda; K Ohnita; K Nakao; S Kohno; S Shikuwa Journal: Endoscopy Date: 2009-08-10 Impact factor: 10.093
Authors: Neal Mehta; Ashraf Abushahin; Meena Sadaps; Mohammad Alomari; John Vargo; Deepa Patil; Rocio Lopez; Matthew Kalady; Conor P Delaney; Emre Gorgun; James Church; Yutaka Saito; Carol A Burke; Amit Bhatt Journal: Surg Endosc Date: 2020-05-29 Impact factor: 4.584
Authors: J Seidel; E Färber; R Baumbach; W Cordruwisch; U Böhmler; B Feyerabend; S Faiss Journal: Int J Colorectal Dis Date: 2016-01-12 Impact factor: 2.571