COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION (CR-ESD), HYBRID ESD (H-ESD) AND RECURRENCE RATE: A WESTERN EUROPEAN EXPERIENCE IN SPAIN

Aims:

1. To compare the recurrence rate after R0 and R1/Rx endoscopic resection (ER), on an ESD “intention-to-treat” basis, in a Western European setting.

2. To evaluate the impact of lateral margin (LM) involvement on local recurrence when neoplasms without risk factors for lymph node metastasis are resected en bloc.

Methods:

We prospectively included 89 consecutive CR neoplasms planned for ESD from September 2008 to December 2015. Kaplan-Meier survival curves were used to assess the recurrence rate over time.

Results:

The ER was aborted in 5 cases (perforation n = 3; technical difficulties n = 2). Surgical intervention was needed after ER because of submucosal or linfovascular invasion in 4 patients. Five out of the remaining 80 cases, were lost to follow-up. Finally, 75 CR neoplasms were included in 74 patients. En bloc resections were obtained in 44 cases (58.7%): 33 ESD (44%) and 11 H-ESD (14.7%). The ER finished piecemeal in the 31 remaining lesions (41.3%). R0 resections (n = 23; 30.7%) were achieved in 18/33 ESD and 5/42 H-ESD [OR = 8.9 (CI 95%: 2.8 – 28.3); p < 0.0001]. The recurrence rate at 3 years showed a statistical significant difference when R0 resections were compared with R1/Rx: 0% vs. 21.5% (p= 0.03). When en bloc resections in ≤ pT1a; ly (-); v (-); pVM0 lesions (n = 44) were analysed separately, LM distribution was: 23 LM0 (52.3%); 18 LM1 (40.9) and 3 LMx (6.8). There was a non-significant trend concerning the recurrence rate when LM0 (n = 23) lesions were compared with LM1/LMx (n = 21): 0% vs. 14.8% at 3 years; p = 0.06.

Conclusions:

R0 resections were associated with lower recurrence rates in comparison with R1/Rx resections. LM involvement increased the recurrence rate but without a statistical significance when this was the only pathological risk factor for recurrence and the specimen was resected en bloc.