Subscribe to RSS
DOI: 10.1055/a-1906-8000
Risk of residual neoplasia after a noncurative colorectal endoscopic submucosal dissection for malignant lesions: a multinational study
Trial Registration: ClinicalTrials.gov Registration number (trial ID): NCT04484311 Type of study: Retrospective multicenter Study
![](https://www.thieme-connect.de/media/endoscopy/202303/lookinside/thumbnails/21895_10-1055-a-1906-8000-1.jpg)
Abstract
Background Endoscopic submucosal dissection (ESD) in colorectal lesions is technically demanding and a significant rate of noncurative procedures is expected. We aimed to assess the rate of residual lesions after a noncurative ESD for colorectal cancer (CRC) and to establish predictive scores to be applied in the clinical setting.
Methods Retrospective multicenter analysis of consecutive colorectal ESDs. Patients with noncurative ESDs performed for the treatment of CRC lesions submitted to complementary surgery or with at least one follow-up endoscopy were included.
Results From 2255 colorectal ESDs, 381 (17 %) were noncurative, and 135 of these were performed in CRC lesions. A residual lesion was observed in 24 patients (18 %). Surgery was performed in 96 patients and 76 (79 %) had no residual lesion in the colorectal wall or in the lymph nodes. The residual lesion rate for sm1 cancers was 0 %, and for > sm1 cancers was also 0 % if no other risk factors were present. Independent risk factors for lymph node metastasis were poor differentiation and lymphatic permeation (NC-Lymph score). Risk factors for the presence of a residual lesion in the wall were piecemeal resection, poor differentiation, and positive/indeterminate vertical margin (NC-Wall score).
Conclusions Lymphatic permeation or poor differentiation warrant surgery owing to their high risk of lymph node metastasis, mainly in > sm1 cancers. In the remaining cases, en bloc and R0 resections resulted in a low risk of residual lesions in the wall. Our scores can be a useful tool for the management of patients who undergo noncurative colorectal ESDs.
Publication History
Received: 21 March 2022
Accepted after revision: 21 July 2022
Accepted Manuscript online:
21 July 2022
Article published online:
10 October 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Park YM, Cho E, Kang HY. et al. The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: a systematic review and metaanalysis. Surg Endosc 2011; 25: 2666-2677
- 2 Yeh JH, Huang RY, Lee CT. et al. Long-term outcomes of endoscopic submucosal dissection and comparison to surgery for superficial esophageal squamous cancer: a systematic review and meta-analysis. Therap Adv Gastroenterol 2020; 13: 1-14
- 3 Fujiya M, Tanaka K, Dokoshi T. et al. Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection. Gastrointest Endosc 2015; 81: 583-595
- 4 Santos-Antunes J, Baldaque-Silva F, Marques M. et al. Real-life evaluation of the safety, efficacy and therapeutic outcomes of endoscopic submucosal dissection in a Western tertiary centre. United European Gastroenterol J 2018; 6: 702-709
- 5 Moss A, Williams SJ, Hourigan LF. et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 2015; 64: 57-65
- 6 Santos-Antunes J, Marques M, Morais R. et al. Colorectal endoscopic submucosal dissection in a Western center: analysis of outcomes and safety profile. GE Port J Gastroenterol 2021; 28: 319-327
- 7 Spychalski M, Wlodarczyk M, Winter K. et al. Outcomes of 601 colorectal endoscopic submucosal dissections in a single Western center: is right colon location still a major concern?. Surg Laparosc Endosc Percutan Tech 2021; 31: 578-583
- 8 Kudo S, Lambert R, Allen JI. et al. Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc 2008; 68 Suppl. 4: S3-S47
- 9 D'Amico F, Amato A, Iannone A. et al. Risk of covert submucosal cancer in patients with granular mixed laterally spreading tumors. Clin Gastroenterol Hepatol 2021; 19: 1395-1401
- 10 Santos-Antunes J, Macedo G. Submucosal cancer in granular mixed type laterally spreading tumors: is universal ESD an acceptable approach in these lesions?. Clin Gastroenterol Hepatol 2021; 19: 1736
- 11 Pimentel-Nunes P, Pioche M, Albeniz E. et al. Curriculum for endoscopic submucosal dissection training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2019; 51: 980-992
- 12 Santos-Antunes J, Marques M, Carneiro F. et al. Very low rate of residual neoplasia after non-curative endoscopic submucosal dissection: a western single-center experience. Eur J Gastroenterol Hepatol 2021; 33: 1161-1166
- 13 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T. et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829-854
- 14 Tanaka S, Kashida H, Saito Y. et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2015; 27: 417-434
- 15 Choi JY, Jung SA, Shim KN. et al. Meta-analysis of predictive clinicopathologic factors for lymph node metastasis in patients with early colorectal carcinoma. J Korean Med Sci 2015; 30: 398-406
- 16 Saito Y, Uraoka T, Yamaguchi Y. et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 2010; 72: 1217-1225
- 17 Thorlacius H, Ronnow CF, Toth E. European experience of colorectal endoscopic submucosal dissection: a systematic review of clinical efficacy and safety. Acta Oncol 2019; 58 Suppl 1: S10-S14
- 18 Ronnow CF, Elebro J, Toth E. et al. Endoscopic submucosal dissection of malignant non-pedunculated colorectal lesions. Endosc Int Open 2018; 6: E961-E968
- 19 Lim XC, Nistala KRY, Ng CH. et al. Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal polyps: A meta-analysis and meta-regression with single arm analysis. World J Gastroenterol 2021; 27: 3925-3939
- 20 Belderbos TD, Leenders M, Moons LM. et al. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy 2014; 46: 388-402
- 21 Cheng P, Lu Z, Zhang M. et al. Is additional surgery necessary after non-curative endoscopic submucosal dissection for early colorectal cancer?. J Invest Surg 2021; 34: 889-894
- 22 Nishimura T, Oka S, Tanaka S. et al. Clinical significance of immunohistochemical lymphovascular evaluation to determine additional surgery after endoscopic submucosal dissection for colorectal T1 carcinoma. Int J Colorectal Dis 2021; 36: 949-958
- 23 Tateishi Y, Nakanishi Y, Taniguchi H. et al. Pathological prognostic factors predicting lymph node metastasis in submucosal invasive (T1) colorectal carcinoma. Mod Pathol 2010; 23: 1068-1072
- 24 Sakuragi M, Togashi K, Konishi F. et al. Predictive factors for lymph node metastasis in T1 stage colorectal carcinomas. Dis Colon Rectum 2003; 46: 1626-1632
- 25 Beaton C, Twine CP, Williams GL. et al. Systematic review and meta-analysis of histopathological factors influencing the risk of lymph node metastasis in early colorectal cancer. Colorectal Dis 2013; 15: 788-797
- 26 Kitajima K, Fujimori T, Fujii S. et al. Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J Gastroenterol 2004; 39: 534-543
- 27 Chen T, Zhang YQ, Chen WF. et al. Efficacy and safety of additional surgery after non-curative endoscopic submucosal dissection for early colorectal cancer. BMC Gastroenterol 2017; 17: 134
- 28 Makimoto S, Takami T, Hatano K. et al. Additional surgery after endoscopic submucosal dissection for colorectal cancer: a review of 53 cases. Int J Colorectal Dis 2019; 34: 1723-1729
- 29 Ahn JH, Kwak MS, Lee HH. et al. Development of a novel prognostic model for predicting lymph node metastasis in early colorectal cancer: analysis based on the Surveillance, Epidemiology, and End Results Database. Front Oncol 2021; 11: 614398
- 30 Ichimasa K, Kudo SE, Mori Y. et al. Correction: Artificial intelligence may help in predicting the need for additional surgery after endoscopic resection of T1 colorectal cancer. Endoscopy 2018; 50: 230-240