WHAT ARE THE RESULTS OF RECTAL ESD IN FRANCE: A LARGE RETROSPECTIVE MULTICENTRE STUDY IN EXPERTS CENTERS

Aims:

ESD has become the standard of care for large superficial rectal precancerous and cancerous lesions. First French results were far from those reported by Japanese teams: En bloc resection: 64%; R0 resection: 53%. Since these first results, experts teams have trained with animal models and in japanese centers. We report here the largest european retrospective multicenter study of four French leading teams in rectal ESD.

Methods:

We performed a retrospective multicenter study of all cases of rectal ESD performed for precancerous or superficial cancerous lesions in four French teams that performed more than 150 ESDs in the last 5 years.

Primary Endpoint was to evaluate the En bloc, R0 and curative resection rate.

Secondary endpoints were:

• evaluation of risk factors for non R0 resection

• evaluation of risk factors for non en bloc resection

• evaluation of the effect of learning curve (before and after 40 ESDs) on the results.

Results:

349 rectal ESDs were performed between 01/06/2010 and 31/12/2016.

Primary endpoint: En bloc resection rate: 95,3%, R0 resection rate: 73%, curative resection rate: 68,5%

Secondary endpoints:

• non en bloc resection was statistically significant associated with a longer procedure duration, a lower speed; a higher perforation rate and a higher rate of recurrent disease

• non R0 resection was statistically significant associated with a longer procedure duration, a lower speed, a higher rate of non exclusive ESD and and a higher rate of recurrent disease

• the beginning of the learning curve was statistically significant associated with a longer procedure duration, a lower speed, a higher rate of post procedural bleeding and longer hospital stay.

Conclusions:

ESD allows a high en bloc and R0 resection in rectal lesions with a low recurrence rate in French expert teams. This retrospective study represent the largest study of rectal ESD in the western world.