PREDICTION OF RESIDUAL NEOPLASIA AFTER A NON-CURATIVE COLORECTAL ESD; A MULTICENTER, MULTINATIONAL STUDY

Aims To assess the rate of residual lesion in the surgical specimen or during the endoscopic follow-up after a non-curative colorectal ESD, and to establish predictive scores to be applied in the clinical setting.

Methods Retrospective multicenter analysis of ESDs performed in epithelial colorectal lesions. Patients with non-curative ESDs that had been submitted to complementary surgery or had at least one follow-up endoscopy were included.

Results From 2214 colorectal ESDs, 340 were included. Residual lesion was observed in 40 (12%) patients. Surgery was performed in 99 patients, and 76 (77%) had no residual lesion in the colorectal wall or lymph node metastasis (LNM). Residual lesion rate for SM1 cancers was 0%; rate of residual lesion for>SM1 cancers was also 0% if no other risk factors were present. Independent risk factors for LNM were poor differentiation and lymphatic permeation (NC-Lymph score). Patients scoring 0, 1, 2 or 3 had a 5%, 25%, 60% and 100% chance of LNM (p<0.001). Risk factors for residual lesion in the wall was colonic location and positive vertical margin (NC-Wall score). Patients with NC-Wall0 had a 0% chance of residual lesion in the wall, raising to 6.7% in NC-Wall1 and 33.3% with NC-Wall2, p<0.001.

Conclusions The presence of lymphatic permeation or poor differentiation in the ESD specimen warrants surgery due to the high risk of LNM. Colonic lesions with positive vertical margin had the highest risk of residual lesion in the wall. Our scores can be a useful tool for the management of patients submitted to non-curative colorectal ESDs.

Publication History

Article published online:
14 April 2022