Long-Term Outcomes of Endoscopic Submucosal Dissection for Colorectal Epithelial Neoplasms: A Systematic Review

SIMPLE SUMMARY: Endoscopic submucosal dissection (ESD) facilitates a successful en bloc resection regardless of tumor size. In this review, we summarize up-to-date reports with long-term observation after ESD for colorectal epithelial neoplasms. The strategy of ESD and additional surgery depending on the curative status showed an excellent five-year disease-specific survival rate. Incomplete resection is a risk factor for local recurrence, and endoscopists must improve their skill level. In non-curative ESD, optimization of additional surgery could reduce disease-specific death without additional surgery. ABSTRACT: In this review, we summarize up-to-date reports with five-year observation after colorectal endoscopic submucosal dissection (ESD). Five-year cause-specific survival rates ranged from 98.6 to 100%. The local recurrence rates ranged from 1.1 to 2.2% in complete resection and 7.5 to 25.0% in incomplete resection. Incomplete resection was a risk factor for local recurrence. In non-curative ESD, five-year cause-specific survival rates ranged from 93.8 to 100% with additional surgery, and 92.7 to 99.1% without surgery. The choice of additional surgery should be based on the individual patient’s age, concomitant diseases, wishes, life expectancy, and the risk of lymph node metastasis. The metachronous cancer rates ranged from 0.22 to 1.1%. Both local recurrence and metachronous tumors should be checked with a follow-up colonoscopy after ESD.