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Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection

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Abstract

Background and Aims

Endoscopic submucosal dissection (ESD) has recently been applied to the treatment of superficial colorectal cancer. Clinical outcomes compared with conventional endoscopic mucosal resection (EMR) have not been determined so our aim was to compare the effectiveness of ESD with conventional EMR for colorectal tumors ≥20 mm.

Methods

This was a retrospective case-controlled study performed at the National Cancer Center Hospital in Tokyo, Japan involving 373 colorectal tumors ≥20 mm determined histologically to be curative resections. Data acquisition was from a prospectively completed database. We evaluated histology, tumor size, procedure time, en bloc resection rate, recurrence rate, and associated complications for both the ESD and EMR groups.

Results

A total of 145 colorectal tumors were treated by ESD and another 228 were treated by EMR. ESD was associated with a longer procedure time (108 ± 71 min/29 ± 25 min; p < 0.0001), higher en bloc resection rate (84%/33%; p < 0.0001) and larger resected specimens (37 ± 14 mm/28 ± 8 mm; p = 0.0006), but involved a similar percentage of cancers (69%/66%; p = NS). There were three (2%) recurrences in the ESD group and 33 (14%) in the EMR group requiring additional EMR (p < 0.0001). The perforation rate was 6.2% (9) in the ESD group and 1.3% (3) in the EMR group (p = NS) with delayed bleeding occurring in 1.4% (2) and 3.1% (7) of the procedures (p = NS), respectively, as all complications were effectively treated endoscopically.

Conclusions

Despite its longer procedure time and higher perforation rate, ESD resulted in higher en bloc resection and curative rates compared with EMR and all ESD perforations were successfully managed by conservative endoscopic treatment.

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Abbreviations

B-knife:

Bipolar needle knife

CO2 :

Carbon dioxide

EMR:

Endoscopic mucosal resection

EPMR:

Endoscopic piecemeal mucosal resection

ESD:

Endoscopic submucosal dissection

IT knife:

Insulation-tipped knife

LN:

Lymph node

sm:

Submucosal

LST:

Laterally spreading tumor

LST-G:

Laterally spreading tumor granular type

LST-NG:

Laterally spreading tumor nongranular type

NS:

Not significant

SD:

Standard deviation

sm1:

Minute submucosal cancer

sm2:

Submucosal deep cancer

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Acknowledgement

The authors wish to thank Christopher Dix for helping to edit this manuscript.

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Authors and Affiliations

  1. Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Yutaka Saito, Masakatsu Fukuzawa, Takahisa Matsuda, Shusei Fukunaga, Taku Sakamoto, Toshio Uraoka, Takeshi Nakajima, Hisatomo Ikehara, Kuang-I Fu, Takao Itoi & Takahiro Fujii

  2. Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan

    Masakatsu Fukuzawa & Takao Itoi

  3. Department of Endoscopy, Okayama University Hospital, Okayama, Japan

    Toshio Uraoka

  4. Endoscopy and Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan

    Hisatomo Ikehara

  5. Department of Gastroenterology, Juntendou University Nerima Hospital, Tokyo, Japan

    Kuang-I Fu

  6. Takahiro Fujii Clinic, Tokyo, Japan

    Takahiro Fujii

Authors
  1. Yutaka Saito
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  2. Masakatsu Fukuzawa
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Correspondence to Yutaka Saito.

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None of the authors has any financial arrangement and there were no funding sources, individuals who provided writing assistance or investigators involved with respect to the content of this manuscript.

As corresponding author, Yutaka Saito have had full access to all of the data presented in this manuscript and take full responsibility for the veracity of the data and its analysis.

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Saito, Y., Fukuzawa, M., Matsuda, T. et al. Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 24, 343–352 (2010). https://doi.org/10.1007/s00464-009-0562-8

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  • DOI: https://doi.org/10.1007/s00464-009-0562-8

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