Subscribe to RSS
Comparison of endoscopic submucosal dissection with laparoscopic-assisted colorectal surgery for early-stage colorectal cancer: a retrospective analysis
submitted 08 April 2012
accepted after revision 10 May 2012
25 September 2012 (online)
Background and study aims: Endoscopic submucosal dissection (ESD) is increasingly being used to resect early colorectal carcinoma, despite the technical difficulties associated with the procedure. Laparoscopic-assisted colorectal surgery (LAC) is an alternative to open surgery for colorectal cancers, and ESD was recently introduced as another alternative. In this study, we compared ESD with LAC as minimally invasive treatments for early colorectal cancer.
Patients and methods: The study included 589 patients (297 patients with colorectal intramucosal or slightly submucosal invasive cancers undergoing ESD; 292 patients with T1 colorectal cancers undergoing LAC) who were treated at National Cancer Center Hospital in Tokyo, Japan, between January 1998 and September 2008. The clinical outcomes of ESD and LAC were evaluated retrospectively and compared on the basis of data that were originally collected prospectively.
Results: In the ESD group, mean tumor size was 37 mm, mean procedure time was 106 minutes, and the en bloc and curative resection rates were 87 % and 80 %, respectively. There were 14 perforations (4.7 %) and 5 cases of postprocedure bleeding (1.7 %); all complications were successfully managed endoscopically except for one of the perforations, which required emergency surgery. In the LAC group, mean tumor size was 20 mm, mean operation time was 206 minutes, and complications included 31 wound infections, 2 pelvic abscesses, 3 anastomotic leakages, and 1 anastomotic bleed. Stomas were necessary in 93 % of the patients who underwent LAC for rectal cancers located below the peritoneal reflection.
Conclusions: ESD was associated with a lower complication rate than LAC, with favorable en bloc and curative resection rates. The safety profile and possibility of curative treatment with colorectal ESD provide advantages for the treatment of early colorectal cancers with nul risk of lymph node metastasis.
- 1 Saito Y, Fujii T, Kondo H et al. Endoscopic treatment for laterally spreading tumors in the colon. Endoscopy 2001; 33: 682-686
- 2 Kudo S, Kashida H, Tamura T et al. Colonoscopic diagnosis and management of nonpolypoid early colorectal cancer. World J Surg 2000; 24: 1081-1090
- 3 Uraoka T, Saito Y, Matsuda T et al. Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut 2006; 55: 1592-1597
- 4 Gotoda T, Kondo H, Ono H et al. A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases. Gastrointest Endosc 1999; 50: 560-563
- 5 Antillon MR, Bartalos CR, Miller ML et al. En bloc endoscopic submucosal dissection of a 14-cm laterally spreading adenoma of the rectum with involvement to the anal canal: expanding the frontiers of endoscopic surgery (with video). Gastrointest Endosc 2008; 67: 332-337
- 6 Kato S, Fu KI, Sano Y et al. Magnifying colonoscopy as a non-biopsy technique for differential diagnosis of non-neoplastic and neoplastic lesions. World J Gastroenterol 2006; 12: 1416-1420
- 7 Matsuda T, Fujii T, Saito Y et al. Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms. Am J Gastroenterol 2008; 103: 2700-2706
- 8 Fu KI, Kato S, Sano Y et al. Staging of early colorectal cancers: magnifying colonoscopy versus endoscopic ultrasonography for estimation of depth of invasion. Dig Dis Sci 2008; 53: 1886-1892
- 9 Saito Y, Uraoka T, Matsuda T et al. A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation. Gastrointest Endosc 2007; 65: 537-542
- 10 Uraoka T, Fujii T, Saito Y et al. Effectiveness of glycerol as a submucosal injection for EMR. Gastrointest Endosc 2005; 61: 736-740
- 11 Saito Y, Uraoka T, Matsuda T et al. Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc 2007; 66: 966-973
- 12 Sano Y, Fu KI, Saito Y et al. A newly developed bipolar-current needle-knife for endoscopic submucosal dissection of large colorectal tumors. Endoscopy 2006; 38 (Suppl. 02) E95
- 13 Kitajima K, Fujimori T, Fujii S et al. The histpathological risk factors for lymph node metastasis in submucosal invasive colorectal carcinoma (in Japanese with English abstract). Stomach Intestine 2004; 39: 1329-1337
- 14 Japanese Society for Cancer of the Colon and Rectum. General rules for clinical and pathological studies on cancer of the colon, rectum and anus. 6th edition. Tokyo: Japanese Society for Cancer of the Colon and Rectum; 1998
- 15 Schlemper RJ, Riddell RH, Kato Y et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
- 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 Kobayashi N, Saito Y, Uraoka T et al. Treatment strategy for laterally spreading tumors in Japan: before and after the introduction of endoscopic submucosal dissection. J Gastroenterol Hepatol 2009; 24: 1387-1392
- 18 Takizawa K, Oda I, Gotoda T et al. Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection – an analysis of risk factors. Endoscopy 2008; 40: 179-183
- 19 Lezoche E, Feliciotti F, Paganini AM et al. Laparoscopic vs. open hemicolectomy for colon cancer – long term outcome. Surg Endosc 2002; 16: 596-602
- 20 Kuntz C, Wunsch A, Bay F et al. Prospective randomized study of stress and immune response after laparoscopic vs conventional colonic resection. Surg Endosc 1998; 12: 963