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Endoscopic submucosal dissection for colorectal neoplasia: outcomes and predictors of recurrence
Background and study aims The role of endoscopic submucosal dissection (ESD) for colorectal lesions in Western communities is unclear and its adoption is still limited. The aim of this study is to assess the long-term outcomes of a large cohort of patients treated with colorectal ESD in a tertiary...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Georg Thieme Verlag KG
2022
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8759944/ https://www.ncbi.nlm.nih.gov/pubmed/35047343 http://dx.doi.org/10.1055/a-1551-3058 |
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author | Maselli, Roberta Spadaccini, Marco Belletrutti, Paul J. Galtieri, Piera Alessia Attardo, Simona Carrara, Silvia Anderloni, Andrea Fugazza, Alessandro Ferrara, Elisa Chiara Pellegatta, Gaia Iannone, Andrea Hassan, Cesare Repici, Alessandro |
author_facet | Maselli, Roberta Spadaccini, Marco Belletrutti, Paul J. Galtieri, Piera Alessia Attardo, Simona Carrara, Silvia Anderloni, Andrea Fugazza, Alessandro Ferrara, Elisa Chiara Pellegatta, Gaia Iannone, Andrea Hassan, Cesare Repici, Alessandro |
author_sort | Maselli, Roberta |
collection | PubMed |
description | Background and study aims The role of endoscopic submucosal dissection (ESD) for colorectal lesions in Western communities is unclear and its adoption is still limited. The aim of this study is to assess the long-term outcomes of a large cohort of patients treated with colorectal ESD in a tertiary Western center. Patients and methods A retrospective analysis was conducted on patients treated by ESD for superficial colorectal lesions between February 2011 and November 2019. The primary outcome was the recurrence rate. Secondary outcomes were en-bloc and R0 resection rates, procedural time, adverse events (AEs), and need for surgery. The curative resection rate was assessed for submucosal invasive lesions. Results A total of 327 consecutive patients, median age 69 years (IQR 60–76); 201 men (61.5 %) were included in the analysis. Of the lesions, 90.8 % were resected in an en-bloc fashion. The rate of R0 resection was 83.1 % (217/261) and 44.0 % (29/66) for standard and hybrid ESD techniques, respectively. Submucosal invasion and piecemeal resection independently predicted R1 resections. A total of 18(5.5 %) intra-procedural AEs (perforation:11, bleeding:7) and 12(3.7 %) post-procedural AEs occurred (perforation:2, bleeding: 10). Eighteen adenoma recurrences per 1,000 person-years (15cases, 5.6 %) were detected after a median follow-up time of 36 months. All recurrences were detected within 12 months. No carcinoma recurrences were observed. R1 resection status and intra-procedural AEs independently predicted recurrences with seven vs 150 recurrences per 1,000 person-years in the R0 vs R1 group, respectively. Conclusions Colorectal ESD is a safe and effective option for managing superficial colorectal neoplasia in a Western setting, with short and long-terms outcomes comparable to Eastern studies. En-bloc R0 resection and absence of intra-procedural AEs are associated with reduced risk of recurrence. |
format | Online Article Text |
id | pubmed-8759944 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Georg Thieme Verlag KG |
record_format | MEDLINE/PubMed |
spelling | pubmed-87599442022-01-18 Endoscopic submucosal dissection for colorectal neoplasia: outcomes and predictors of recurrence Maselli, Roberta Spadaccini, Marco Belletrutti, Paul J. Galtieri, Piera Alessia Attardo, Simona Carrara, Silvia Anderloni, Andrea Fugazza, Alessandro Ferrara, Elisa Chiara Pellegatta, Gaia Iannone, Andrea Hassan, Cesare Repici, Alessandro Endosc Int Open Background and study aims The role of endoscopic submucosal dissection (ESD) for colorectal lesions in Western communities is unclear and its adoption is still limited. The aim of this study is to assess the long-term outcomes of a large cohort of patients treated with colorectal ESD in a tertiary Western center. Patients and methods A retrospective analysis was conducted on patients treated by ESD for superficial colorectal lesions between February 2011 and November 2019. The primary outcome was the recurrence rate. Secondary outcomes were en-bloc and R0 resection rates, procedural time, adverse events (AEs), and need for surgery. The curative resection rate was assessed for submucosal invasive lesions. Results A total of 327 consecutive patients, median age 69 years (IQR 60–76); 201 men (61.5 %) were included in the analysis. Of the lesions, 90.8 % were resected in an en-bloc fashion. The rate of R0 resection was 83.1 % (217/261) and 44.0 % (29/66) for standard and hybrid ESD techniques, respectively. Submucosal invasion and piecemeal resection independently predicted R1 resections. A total of 18(5.5 %) intra-procedural AEs (perforation:11, bleeding:7) and 12(3.7 %) post-procedural AEs occurred (perforation:2, bleeding: 10). Eighteen adenoma recurrences per 1,000 person-years (15cases, 5.6 %) were detected after a median follow-up time of 36 months. All recurrences were detected within 12 months. No carcinoma recurrences were observed. R1 resection status and intra-procedural AEs independently predicted recurrences with seven vs 150 recurrences per 1,000 person-years in the R0 vs R1 group, respectively. Conclusions Colorectal ESD is a safe and effective option for managing superficial colorectal neoplasia in a Western setting, with short and long-terms outcomes comparable to Eastern studies. En-bloc R0 resection and absence of intra-procedural AEs are associated with reduced risk of recurrence. Georg Thieme Verlag KG 2022-01-14 /pmc/articles/PMC8759944/ /pubmed/35047343 http://dx.doi.org/10.1055/a-1551-3058 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited. |
spellingShingle | Maselli, Roberta Spadaccini, Marco Belletrutti, Paul J. Galtieri, Piera Alessia Attardo, Simona Carrara, Silvia Anderloni, Andrea Fugazza, Alessandro Ferrara, Elisa Chiara Pellegatta, Gaia Iannone, Andrea Hassan, Cesare Repici, Alessandro Endoscopic submucosal dissection for colorectal neoplasia: outcomes and predictors of recurrence |
title | Endoscopic submucosal dissection for colorectal neoplasia: outcomes and predictors of recurrence |
title_full | Endoscopic submucosal dissection for colorectal neoplasia: outcomes and predictors of recurrence |
title_fullStr | Endoscopic submucosal dissection for colorectal neoplasia: outcomes and predictors of recurrence |
title_full_unstemmed | Endoscopic submucosal dissection for colorectal neoplasia: outcomes and predictors of recurrence |
title_short | Endoscopic submucosal dissection for colorectal neoplasia: outcomes and predictors of recurrence |
title_sort | endoscopic submucosal dissection for colorectal neoplasia: outcomes and predictors of recurrence |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8759944/ https://www.ncbi.nlm.nih.gov/pubmed/35047343 http://dx.doi.org/10.1055/a-1551-3058 |
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