Non-Curative Endoscopic Submucosal Dissection (ESD) for Colorectal Cancer: Clinical Outcomes and Predictors of Recurrence

Aims Endoscopic submucosal dissection(ESD)is an organ-preserving approach pursuing curative intent for the removal of superficially invasive colorectal cancers(CRCs) with negligible risk for lymph-node metastasis. Conversely, additional surgical resection is recommended in case of high risk of nodal involvement based on histo-pathological features. However, both the actual risk of a lymph-node disease and the clinical outcomes of patients who underwent non-curative ESD has never been investigated. The aim of this study is to report outcomes of these patients from a large Western cohort.

Methods This was a retrospective analysis of consecutive patients with CRC who underwent ESD at 13 tertiary-care centers. All lesions with histo-pathologic features of high risk of nodal involvement were considered for the analysis, regardless of post-endoscopic management (Conservative vs Surgery). Primary outcomes were disease recurrence, death and disease-related death rates after non-curative ESD in the two groups. As secondary outcomes, we assessed the rate of residual disease (RD) at both the previous resection site and regional lymph-nodes among patients who underwent surgery. Endoscopic and histologic variables were investigated as risk factors for RD.

Results From October 2012 to November 2019, 3373 patients have been treated by colorectal ESD and 207 non-curative resections were considered for the analysis. The 60.9 % (n=126) of these patients were referred for surgery, and the remaining 39.1 % (n=81) were followed up. In a mean time of 27.6±18.6 months, there was no difference in term of recurrence rate between the two groups (p = 0.30). The Conservative group showed a higher risk of death for any causes compared to the Surgery group (HR=3.99,p = 0.013). Conversely no difference was reported considering disease-specific survival rate. Among patients who underwent additional surgery, 25patients (19.8 %) had histological evidence of RD, with lymphatic-vascular invasion (HR=3.48,p = 0.009) and depth of invasion>sm (HR=4.98,p = 0.017) emerged as independent predictors.

Conclusions Additional surgical resection may be not clinically relevant in all cases of non-curative ESD. Lymphatic-vascular invasion and/or the neoplastic involvement of the muscular layer should strongly suggest a surgical approach.

Citation: Spadaccini M, Bourke M, Maselli R et al. OP81 NON-CURATIVE ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) FOR COLORECTAL CANCER: CLINICAL OUTCOMES AND PREDICTORS OF RECURRENCE. Endoscopy 2021; 53: S34.

Publication History

Article published online:
19 March 2021