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Endoscopy 2023; 55(03): 235-244
DOI: 10.1055/a-1906-8000
Original article

Risk of residual neoplasia after a noncurative colorectal endoscopic submucosal dissection for malignant lesions: a multinational study

João Santos-Antunes 
 1   Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
 2   Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal
,
Mathieu Pioche
 3   Department of Hepatology and Gastroenterology, Edouard Herriot Hospital, Lyon, France
,
Felipe Ramos-Zabala 
 4   Department of Gastroenterology, Department of Clinical Medical Sciences, Hospital Universitario HM Montepríncipe, HM Hospitales, Universidad San Pablo-CEU, CEU Universities Madrid, Madrid, Spain
,
Paolo Cecinato 
 5   Gastroenterology and Digestive Endoscopy Unit, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy
,
Francisco J. Gallego Rojo
 6   Gastroenterology Department, Hospital de Poniente, Almería, Spain
,
Pedro Barreiro
 7   Gastroenterology Department, Centro Hospitalar Lisboa Ocidental EPE, Lisbon, Portugal
 8   Lisbon Advanced Endoscopic Center, Hospital Lusíadas, Lisbon, Portugal
,
Catarina Félix 
 7   Gastroenterology Department, Centro Hospitalar Lisboa Ocidental EPE, Lisbon, Portugal
,
Sandro Sferrazza
 9   Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, Trento, Italy
,
Frieder Berr
10   Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Salzburg, Austria
,
Andrej Wagner
10   Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Salzburg, Austria
,
Arnaud Lemmers 
11   Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
,
Mariana Figueiredo Ferreira
11   Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
,
Eduardo Albéniz 
12   Navarrabiomed Research Institute, Complejo Hospitalario de Navarra, Public University of Navarra, IdiSNA, Pamplona, Spain
,
Hugo Uchima
13   Digestive Endoscopy Service, Centro Médico Teknon, Barcelona, Spain
14   Gastroenterology Service, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
,
Ricardo Küttner-Magalhães 
15   Gastroenterology Department, Hospital Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
,
Carlos Fernandes
16   Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
,
Rui Morais 
 1   Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
,
Sunil Gupta 
17   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
,
Daniel Martinho-Dias
18   Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Porto, Portugal
,
Elisabete Rios
19   Pathology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
,
Isabel Faria-Ramos
 2   Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal
,
Margarida Marques
 1   Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
,
Michael J. Bourke
17   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
,
Guilherme Macedo
 1   Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
› Author AffiliationsTrial Registration: ClinicalTrials.gov Registration number (trial ID): NCT04484311 Type of study: Retrospective multicenter Study
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Referred to by:

Pathologic sm2 carries a moderate risk of metastases even without other unfavorable factors, but positive horizontal margins have low local recurrence risk after en bloc resectionEndoscopy 2023; 55(03): 252-254
DOI: 10.1055/a-1996-0826

Referred to by:

Author commentary on João Santos-Antunes et al.Endoscopy 2023; 55(03): v8-v8
DOI: 10.1055/a-1929-8049

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.

Fig. 1 s, Tables 1 s–2 s



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

 

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