Endoscopic Submucosal Dissection Decreases Additional Colorectal Resection for T1 Colorectal Cancer

Abstract

BackgroundThere are 3 methods of treating T1 colorectal cancer (T1 CRC), which include endoscopic resection, endoscopic resection followed by additional colorectal resection, and surgical resection. In this retrospective study, changes in the management of T1 CRC after introduction of endoscopic submucosal dissection (ESD) were investigated by comparison with the 10-year period before introduction of ESD.Material/MethodsDuring a 20-year period from 1996 to 2015, 835 patients with T1 CRC were treated, including 331 patients before introduction of ESD (Group A) and 504 patients after introduction of ESD (Group B). Clinicopathological findings and treatment methods were compared between these 2 groups.ResultsAs the initial treatment, endoscopic treatment was performed in 185 patients (55.9%) in Group A and 288 (57.1%) in Group B. In Group B, ESD was performed in 161 patients (55.9%), accounting for more than half of the T1 CRC patients receiving endoscopic treatment. In Groups A and B, observation after endoscopic resection was selected for 54.2% and 67.3% of T1a patients, respectively (p=0.04). A similar trend was noted for T1b patients, and there was no significant difference of the treatment approach. Among all T1 CRC patients, the percentage undergoing observation after endoscopic resection was significantly higher in Group B than in Group A (34.3% vs. 26.9%, p=0.02), and the percentage of patients undergoing additional colorectal resection was significantly lower in Group B (22.8% vs. 29.0%, p=0.04).ConclusionsAfter introduction of ESD, it was performed in more than half of all patients with T1 CRC undergoing endoscopic treatment. The percentage of patients undergoing observation following endoscopic resection of T1 CRC increased after introduction of ESD.

Requirement of Additional Surgery after Non-Curative Endoscopic Submucosal Dissection for Early Colorectal Cancer

“…Moreover, additional surgery is highly recommended in cases with lymphovascular infiltration. Consistent with this idea, previous studies also reported the association between lymphovascular infiltration and regional LNM [1,5,6]. Thus, this study sheds light on the management of colorectal cancers after non-curative ESD.…”

“…Endoscopic submucosal dissection (ESD) is widely used for early colorectal cancer as a curative treatment. ESD enables endoscopists to perform en block resection with a higher success rate as compared with conventional endoscopic mucosal resection (EMR) [1,2]. In addition, accurate histopathological evaluation is easier in ESD than in EMR [1,2].…”

“…ESD enables endoscopists to perform en block resection with a higher success rate as compared with conventional endoscopic mucosal resection (EMR) [1,2]. In addition, accurate histopathological evaluation is easier in ESD than in EMR [1,2]. The introduction of ESD has expanded the indication of endoscopic treatments for colorectal tumors and now large tumors exhibiting submucosal invasion can be treated with ESD.…”

Additional Surgical Resection After Endoscopic Resection for Patients With High-risk T1 Colorectal Cancer

“…ASR also has an increased risk of surgical morbidities like anastomotic leakage and stoma formation compared to local excision, and they may complicate patient course and recovery. On the other hand, ER is minimally invasive for diagnosis and treatment (5,11). Complete local resection with negative vertical margin may lead to curative conditions.…”

Pathologic evaluation of endoscopically resected non-ampullary duodenal lesions: a single center experience

“…Since the introduction of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in Japan to treat gastrointestinal neoplasms (4,5), endoscopic resections (ER) are increasingly being used as a therapeutic option for various type of malignant and benign lesions throughout the gastrointestinal tract (6)(7)(8)(9)(10)(11). EMR is a relatively simpler technique that allows the removal of lesions limited to the mucosa.…”