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Low risk of local recurrence after a successful en bloc endoscopic submucosal dissection for noninvasive colorectal lesions with positive horizontal resection margins (R-ESD study)

Background  During endoscopic submucosal dissection (ESD), the normal mucosa is cut under constant optical control. We studied whether a positive horizontal resection margin after a complete en bloc ESD predicts local recurrence. Methods  In this European multicenter cohort study, patients with a co...

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Autores principales: Haasnoot, Krijn J. C., Baldaque-Silva, Francisco, Koch, Arjun, Figueiredo Ferreira, Mariana, Santos-Antunes, João, Dias, Emanuel, Omae, Masami, van Tilburg, Laurelle, Dang, Hao, Lemmers, Arnaud, Boonstra, Jurjen J., Moons, Leon M. G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2023
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9974332/
https://www.ncbi.nlm.nih.gov/pubmed/36228648
http://dx.doi.org/10.1055/a-1960-3552
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author Haasnoot, Krijn J. C.
Baldaque-Silva, Francisco
Koch, Arjun
Figueiredo Ferreira, Mariana
Santos-Antunes, João
Dias, Emanuel
Omae, Masami
van Tilburg, Laurelle
Dang, Hao
Lemmers, Arnaud
Boonstra, Jurjen J.
Moons, Leon M. G.
author_facet Haasnoot, Krijn J. C.
Baldaque-Silva, Francisco
Koch, Arjun
Figueiredo Ferreira, Mariana
Santos-Antunes, João
Dias, Emanuel
Omae, Masami
van Tilburg, Laurelle
Dang, Hao
Lemmers, Arnaud
Boonstra, Jurjen J.
Moons, Leon M. G.
author_sort Haasnoot, Krijn J. C.
collection PubMed
description Background  During endoscopic submucosal dissection (ESD), the normal mucosa is cut under constant optical control. We studied whether a positive horizontal resection margin after a complete en bloc ESD predicts local recurrence. Methods  In this European multicenter cohort study, patients with a complete en bloc colorectal ESD were selected from prospective registries. Cases were defined by a horizontal resection margin that was positive or indeterminate for dysplasia (HM1), whereas controls had a free resection margin (HM0). Low risk lesions with submucosal invasion (T1) and margins free of carcinoma were analyzed separately. The main outcome was local recurrence. Results  From 928 consecutive ESDs (2011–2020), 354 patients (40 % female; mean age 67 years, median follow-up 23.6 months), with 308 noninvasive lesions and 46 T1 lesions, were included. The recurrence rate for noninvasive lesions was 1/212 (0.5 %; 95 %CI 0.02 %–2.6 %) for HM0 vs. 2/96 (2.1 %; 95 %CI 0.57 %–7.3 %) for HM1. The recurrence rate for T1 lesions was 1/38 (2.6 %; 95 %CI 0.14 %–13.5 %) for HM0 vs. 2/8 (25 %; 95 %CI 7.2 %–59.1 %) for HM1. Conclusion  A positive horizontal resection margin after an en bloc ESD for noninvasive lesions is associated with a marginal nonsignificant increase in the local recurrence rate, equal to an ESD with clear horizontal margins. This could not be confirmed for T1 lesions.
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spelling pubmed-99743322023-03-01 Low risk of local recurrence after a successful en bloc endoscopic submucosal dissection for noninvasive colorectal lesions with positive horizontal resection margins (R-ESD study) Haasnoot, Krijn J. C. Baldaque-Silva, Francisco Koch, Arjun Figueiredo Ferreira, Mariana Santos-Antunes, João Dias, Emanuel Omae, Masami van Tilburg, Laurelle Dang, Hao Lemmers, Arnaud Boonstra, Jurjen J. Moons, Leon M. G. Endoscopy Background  During endoscopic submucosal dissection (ESD), the normal mucosa is cut under constant optical control. We studied whether a positive horizontal resection margin after a complete en bloc ESD predicts local recurrence. Methods  In this European multicenter cohort study, patients with a complete en bloc colorectal ESD were selected from prospective registries. Cases were defined by a horizontal resection margin that was positive or indeterminate for dysplasia (HM1), whereas controls had a free resection margin (HM0). Low risk lesions with submucosal invasion (T1) and margins free of carcinoma were analyzed separately. The main outcome was local recurrence. Results  From 928 consecutive ESDs (2011–2020), 354 patients (40 % female; mean age 67 years, median follow-up 23.6 months), with 308 noninvasive lesions and 46 T1 lesions, were included. The recurrence rate for noninvasive lesions was 1/212 (0.5 %; 95 %CI 0.02 %–2.6 %) for HM0 vs. 2/96 (2.1 %; 95 %CI 0.57 %–7.3 %) for HM1. The recurrence rate for T1 lesions was 1/38 (2.6 %; 95 %CI 0.14 %–13.5 %) for HM0 vs. 2/8 (25 %; 95 %CI 7.2 %–59.1 %) for HM1. Conclusion  A positive horizontal resection margin after an en bloc ESD for noninvasive lesions is associated with a marginal nonsignificant increase in the local recurrence rate, equal to an ESD with clear horizontal margins. This could not be confirmed for T1 lesions. Georg Thieme Verlag KG 2023-01-12 /pmc/articles/PMC9974332/ /pubmed/36228648 http://dx.doi.org/10.1055/a-1960-3552 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Haasnoot, Krijn J. C.
Baldaque-Silva, Francisco
Koch, Arjun
Figueiredo Ferreira, Mariana
Santos-Antunes, João
Dias, Emanuel
Omae, Masami
van Tilburg, Laurelle
Dang, Hao
Lemmers, Arnaud
Boonstra, Jurjen J.
Moons, Leon M. G.
Low risk of local recurrence after a successful en bloc endoscopic submucosal dissection for noninvasive colorectal lesions with positive horizontal resection margins (R-ESD study)
title Low risk of local recurrence after a successful en bloc endoscopic submucosal dissection for noninvasive colorectal lesions with positive horizontal resection margins (R-ESD study)
title_full Low risk of local recurrence after a successful en bloc endoscopic submucosal dissection for noninvasive colorectal lesions with positive horizontal resection margins (R-ESD study)
title_fullStr Low risk of local recurrence after a successful en bloc endoscopic submucosal dissection for noninvasive colorectal lesions with positive horizontal resection margins (R-ESD study)
title_full_unstemmed Low risk of local recurrence after a successful en bloc endoscopic submucosal dissection for noninvasive colorectal lesions with positive horizontal resection margins (R-ESD study)
title_short Low risk of local recurrence after a successful en bloc endoscopic submucosal dissection for noninvasive colorectal lesions with positive horizontal resection margins (R-ESD study)
title_sort low risk of local recurrence after a successful en bloc endoscopic submucosal dissection for noninvasive colorectal lesions with positive horizontal resection margins (r-esd study)
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9974332/
https://www.ncbi.nlm.nih.gov/pubmed/36228648
http://dx.doi.org/10.1055/a-1960-3552
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