Clinical outcomes of endoscopic submucosal dissection for colorectal tumors: a large multicenter retrospective study from the Hiroshima GI Endoscopy Research Group

• Published in: Gastrointestinal endoscopy 2018-03, Vol.87 (3), p.714-722
• Main Authors: Boda, Kazuki, Oka, Shiro, Tanaka, Shinji, Nagata, Shinji, Kunihiro, Masaki, Kuwai, Toshio, Hiraga, Yuko, Furudoi, Akira, Terasaki, Motomi, Nakadoi, Koichi, Higashiyama, Makoto, Okanobu, Hideharu, Akagi, Morihisa, Chayama, Kazuaki
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Colonoscopy - methods; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Endoscopic Mucosal Resection - adverse effects; Endoscopic Mucosal Resection - methods; Female; Humans; Intestinal Mucosa - pathology; Intestinal Mucosa - surgery; Male; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies; Survival Rate; Treatment Outcome
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2017.05.051

Although advanced high-volume centers have reported good outcomes of colorectal endoscopic submucosal dissection (ESD), a limited number of highly skilled experts in specialized institutions performed these procedures. We undertook a retrospective multicenter survey, which included nonspecialized hospitals, to investigate the clinical outcomes of colorectal ESD. We recruited 1233 consecutive patients with 1259 colorectal tumors resected by ESD at 12 institutions. We evaluated the en bloc resection rate, histologic complete resection rate, curative (R0) resection rate, adverse events, and the long-term prognoses, including local recurrence, metachronous tumor development, and survival rate. The en bloc, histologic complete, and R0 resection rates were 92.6%, 87.4%, and 83.7%, respectively. The delayed bleeding, intraoperative perforation, and delayed perforation rates were 3.7%, 3.4%, and .4%, respectively. The long-term outcomes analysis included 1091 patients (88.4%). Local recurrences occurred in 1.7%, and metachronous tumors (>5 mm) developed in 11.0% of the patients. The 3- and 5-year overall survival rates were 95.1% and 92.3%, respectively. The number of colonic tumors, severe submucosal fibrosis, and en bloc resection rates were significantly higher in the high-volume centers (Group H) than those in the low-volume centers (Group L). The average tumor size in Group H was significantly larger than that in Group L. Colorectal ESDs are feasible, have acceptable adverse event risks, and favorable long-term prognoses. (Clinical trial registration number: UMIN000016197.)