Risk of submucosal invasive cancer and high-grade dysplasia in a Multicentre Western Cohort of ESD treated colorectal lesion

Aims Although ESD is preferred for rectal adenomatous lesions larger than 20 mm, there is less agreement related similar lesions located in the colon. Recent publications advocate that pEMR should be preferred, as lateral spreading tumours (LST) resected by pEMR in the right colon have a low rate of cancer (4.4%) [1] [2]. However, Japanese studies showed a post ESD risk of submucosal invasive cancer and high-grade dysplasia of ~ 8-27% [3] [4]. We set up a European multicenter retrospective study to assess the prevalence of submucosal invasive cancer (SMIC) and high-grade dysplasia (HGD) in a cohort of colorectal LST treated by ESD.

Methods European centers were invited to fill in a database of consecutive patients. Clinical variables related to patients and procedures as well as the center’s resection strategy for colorectal LST dissection (selective or universal colorectal ESD) were recorded. The prevalence of HGD and SMIC in the left colon (LC – splenic flexure to sigmoid) and right colon (RC – caecum to transverse colon) and rectum (RE) were recorded and a logistic regression analysis was performed to test the data. Preliminary data are presented.

Results 17 European centers provided data on 2454 lesions, 614 in the RC, 375 in the LC and 1465 in RE. 520 lesions were resected with an universal colorectal ESD approach, 1726 with a universal rectal – selective ESD colon approach, 205 with a selective colorectal ESD approach. There were statistically significant differences in the case mix of RC, LC and RE, with smaller lesions in the RC and LC when compared to RE (RC 39.8mm±17.0; LC 38.8mm±17.0; RE 48.8±27.2mm p<0.001). RE had higher prevalence of LST-G-M (55.2%; RC 31.9%; LC 21.7%, p<0.001). LST-NG-FE prevalence was higher in the RC (32.1%; LC 22.4%; RE 6.1%, p<0.001). LST-NG-PD were more frequent in colonic lesions (RC 15.6%, LC 13.3%, vs RE 3.9% p<0.001). Sessile lesions were more common in LC (18.4%) and RE (17.9%) than RC (6.7%, p<0.001). The LC and RE had higher prevalence of SMIC when compared to the RC (RC 10.4%; LC 19.5%; RE 19.8% p≤0.001). A multivariate analysis was carried out on the overall cohort and separately on the RC, LC and RE cohorts to find risk factors associated with SMIC (variables considered: age, gender, dimensions, resection strategy, nodular component, morphology – LST classification). On the overall cohort, right colon location and morphology LST-G-H are protective factors against the risk of SMIC. In RC, LST-G-M and LST-NG-PD are risks factor for SMIC. No variable was significative for increased odds of SMIC in LC. Male gender and morphology other than LST-G-H (apart from semi-peduncolated) were risks factor for increased SMIC in RE.

Conclusions Our current data suggest that ESD would be suggested as universal strategy in the left colon and rectum, a selection strategy is advised on the right colon to achieve cost-effectiveness. Different odds ratio are associated with polyp morphology depending on the location. Right colon is a protective factor against the risk of SMIC, whereas left colon has similar rates to rectum.

Publication History

Article published online:
27 March 2025

• References

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