Tao Chen1, Li-Qing Yao1, Mei-Dong Xu1, Yi-Qun Zhang1, Wei-Feng Chen1, Qiang Shi1, Shi-Lun Cai1, Yin-Yin Chen2, Yan-Hong Xie3, Yuan Ji3, Shi-Yao Chen4, Ping-Hong Zhou5, Yun-Shi Zhong6. 1. Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, China; Endoscopy Research Institute of Fudan University, Shanghai, China. 2. Department of Diagnostic Radiology, Zhongshan Hospital of Fudan University, Shanghai, China. 3. Department of Pathology, Zhongshan Hospital of Fudan University, Shanghai, China. 4. Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, China; Department of Gastroenterology, Zhongshan Hospital of Fudan University, Shanghai, China. 5. Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, China; Endoscopy Research Institute of Fudan University, Shanghai, China. Electronic address: pinghongzhou@yahoo.com. 6. Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, China; Endoscopy Research Institute of Fudan University, Shanghai, China. Electronic address: zhongamy2002@yahoo.com.
Abstract
BACKGROUND & AIMS: Although endoscopic submucosal dissection (ESD) of colorectal carcinoids is increasing, little is known about long-term outcomes of patients. We investigated the efficacy and safety of ESD of colorectal carcinoids and evaluated long-term outcomes, including local recurrence and metastasis. METHODS: We performed a retrospective analysis of data collected from 239 consecutive patients with colorectal carcinoids <20 mm who underwent endoscopic ultrasonography (to evaluate the size of tumor and the depth of invasion), followed by ESD from January 2007 through October 2012 at the Zhongshan Hospital of Fudan University. Histology and patient data were collected during a median follow-up period of 52 months (range, 25-94 months) to determine tumor stage and type, completeness of resection, complications, tumor recurrence, and distant metastasis. RESULTS: En bloc resection was achieved for all of the 239 treated lesions; tumor tissues were completely resected for 216 of the lesions (90.38%). Eight patients had ESD-related complications (3.35%). As more ESDs were performed by endoscopists, the rate of complete tumor resection increased, and the rate of complications decreased. ESD of carcinoids in colon increased the risk of non-R0 resection and the rate of complications. During the follow-up period, all patients remained free from local recurrence. However, distant metastases were detected in 6 patients (2.51%); lymphovascular invasion was a risk factor for metastasis. CONCLUSIONS: ESD is effective for the resection of rectal carcinoids <20 mm and causes complications in less than 4% of patients. ESD for colonic carcinoids is feasible but associated with a higher non-R0 resection rate and a trend toward higher complications risk. Tumor features and stage determine risk for distant metastasis, so long-term follow-up is essential.
BACKGROUND & AIMS: Although endoscopic submucosal dissection (ESD) of colorectal carcinoids is increasing, little is known about long-term outcomes of patients. We investigated the efficacy and safety of ESD of colorectal carcinoids and evaluated long-term outcomes, including local recurrence and metastasis. METHODS: We performed a retrospective analysis of data collected from 239 consecutive patients with colorectal carcinoids <20 mm who underwent endoscopic ultrasonography (to evaluate the size of tumor and the depth of invasion), followed by ESD from January 2007 through October 2012 at the Zhongshan Hospital of Fudan University. Histology and patient data were collected during a median follow-up period of 52 months (range, 25-94 months) to determine tumor stage and type, completeness of resection, complications, tumor recurrence, and distant metastasis. RESULTS: En bloc resection was achieved for all of the 239 treated lesions; tumor tissues were completely resected for 216 of the lesions (90.38%). Eight patients had ESD-related complications (3.35%). As more ESDs were performed by endoscopists, the rate of complete tumor resection increased, and the rate of complications decreased. ESD of carcinoids in colon increased the risk of non-R0 resection and the rate of complications. During the follow-up period, all patients remained free from local recurrence. However, distant metastases were detected in 6 patients (2.51%); lymphovascular invasion was a risk factor for metastasis. CONCLUSIONS: ESD is effective for the resection of rectal carcinoids <20 mm and causes complications in less than 4% of patients. ESD for colonic carcinoids is feasible but associated with a higher non-R0 resection rate and a trend toward higher complications risk. Tumor features and stage determine risk for distant metastasis, so long-term follow-up is essential.
Authors: Hong Kyu Lim; Seong Jun Lee; Dong Hoon Baek; Do Youn Park; Bong Eun Lee; Eun Young Park; Joon Woo Park; Gwang Ha Kim; Geun Am Song Journal: Gastroenterol Res Pract Date: 2019-09-16 Impact factor: 2.260
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