Kazuki Boda1, Shiro Oka1, Shinji Tanaka2, Shinji Nagata3, Masaki Kunihiro4, Toshio Kuwai5, Yuko Hiraga6, Akira Furudoi7, Motomi Terasaki8, Koichi Nakadoi9, Makoto Higashiyama10, Hideharu Okanobu11, Morihisa Akagi12, Kazuaki Chayama1. 1. Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan. 2. Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan. 3. Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan. 4. Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan. 5. Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan. 6. Department of Endoscopy, Hiroshima Prefectural Hospital, Hiroshima, Japan. 7. Department of Gastroenterology, JA Hiroshima General Hospital, Hiroshima, Japan. 8. Department of Gastroenterology, Miyoshi Central Hospital. 9. Department of Gastroenterology, Onomichi General Hospital. 10. Department of Gastroenterology, Shobara Red Cross Hospital. 11. Department of Gastroenterology, Chugoku Rosai Hospital. 12. Department of Gastroenterology, Prefectural Akitsu Hospital.
Abstract
BACKGROUND AND AIMS: Although advanced high-volume centers have reported good outcomes of colorectal endoscopic submucosal dissection (ESD), a limited number of highly skilled experts in specialized institutions performed these procedures. We undertook a retrospective multicenter survey, which included nonspecialized hospitals, to investigate the clinical outcomes of colorectal ESD. METHODS: We recruited 1233 consecutive patients with 1259 colorectal tumors resected by ESD at 12 institutions. We evaluated the en bloc resection rate, histologic complete resection rate, curative (R0) resection rate, adverse events, and the long-term prognoses, including local recurrence, metachronous tumor development, and survival rate. RESULTS: The en bloc, histologic complete, and R0 resection rates were 92.6%, 87.4%, and 83.7%, respectively. The delayed bleeding, intraoperative perforation, and delayed perforation rates were 3.7%, 3.4%, and .4%, respectively. The long-term outcomes analysis included 1091 patients (88.4%). Local recurrences occurred in 1.7%, and metachronous tumors (>5 mm) developed in 11.0% of the patients. The 3- and 5-year overall survival rates were 95.1% and 92.3%, respectively. The number of colonic tumors, severe submucosal fibrosis, and en bloc resection rates were significantly higher in the high-volume centers (Group H) than those in the low-volume centers (Group L). The average tumor size in Group H was significantly larger than that in Group L. CONCLUSIONS: Colorectal ESDs are feasible, have acceptable adverse event risks, and favorable long-term prognoses. (Clinical trial registration number: UMIN000016197.).
BACKGROUND AND AIMS: Although advanced high-volume centers have reported good outcomes of colorectal endoscopic submucosal dissection (ESD), a limited number of highly skilled experts in specialized institutions performed these procedures. We undertook a retrospective multicenter survey, which included nonspecialized hospitals, to investigate the clinical outcomes of colorectal ESD. METHODS: We recruited 1233 consecutive patients with 1259 colorectal tumors resected by ESD at 12 institutions. We evaluated the en bloc resection rate, histologic complete resection rate, curative (R0) resection rate, adverse events, and the long-term prognoses, including local recurrence, metachronous tumor development, and survival rate. RESULTS: The en bloc, histologic complete, and R0 resection rates were 92.6%, 87.4%, and 83.7%, respectively. The delayed bleeding, intraoperative perforation, and delayed perforation rates were 3.7%, 3.4%, and .4%, respectively. The long-term outcomes analysis included 1091 patients (88.4%). Local recurrences occurred in 1.7%, and metachronous tumors (>5 mm) developed in 11.0% of the patients. The 3- and 5-year overall survival rates were 95.1% and 92.3%, respectively. The number of colonic tumors, severe submucosal fibrosis, and en bloc resection rates were significantly higher in the high-volume centers (Group H) than those in the low-volume centers (Group L). The average tumor size in Group H was significantly larger than that in Group L. CONCLUSIONS:Colorectal ESDs are feasible, have acceptable adverse event risks, and favorable long-term prognoses. (Clinical trial registration number: UMIN000016197.).
Authors: Miguel Araújo-Martins; Pedro Pimentel-Nunes; Diogo Libânio; Marta Borges-Canha; Mário Dinis-Ribeiro Journal: GE Port J Gastroenterol Date: 2019-09-06