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Efficacy and safety of colorectal endoscopic submucosal dissection in patients with sarcopenia

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Abstract

Background

Endoscopic submucosal dissection (ESD) for early-stage colorectal cancer (CRC) has become a common and useful treatment. Although sarcopenia has been identified as an independent risk factor for complications after surgery for CRC, whether sarcopenia is also an independent risk factor for complications after colorectal ESD remains to be clarified. The aim of this study was to compare the outcomes of colorectal ESD in patients with and those without sarcopenia.

Methods

This is a retrospective cohort study. A total of 334 patients underwent colorectal ESD for 361 neoplasms at Hiratsuka City Hospital from March 2012 to October 2018. The neoplasms were divided into two groups depending on the presence or absence of sarcopenia in the patients.

Results

Overall, 334 patients underwent colorectal ESD for 361 neoplasms during the study period. We excluded 90 patients (90 neoplasms), and 244 patients (277 neoplasms) were included in the final analysis (134 from the sarcopenia group, 137 from the non-sarcopenia group). The en-bloc resection rate was high and was not significantly different between the sarcopenia group [126/134 (94.1%)] and the non-sarcopenia group [133/137 (97.1%)], P = 0.1778). The rate of perforation and the rate of delayed bleeding were not significantly different between the sarcopenia group and the non-sarcopenia group [6/134 (4.5%) vs. 9/137 (6.6%), P = 0.314, 4/134 (3%) vs. 6/137 (4.4%), P = 0.3885, respectively].

Conclusions

The presence of sarcopenia did not influence the rate of complications after ESD. Colorectal ESD is safe and effective even in patients with sarcopenia. Prospective multicenter studies are necessary to confirm our results.

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Abbreviations

CRC:

Colorectal cancer

ESD:

Endoscopic submucosal dissection

CT:

Computed tomography

PECS:

Post-ESD coagulation syndrome

POD:

Post-ESD day

SMI:

Skeletal muscle index

SD:

Standard deviation

OR:

Odds ratio

95% CI:

95% Confidence interval

LAC:

Laparoscopic-assisted colectomy

OS:

Overall survival

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Acknowledgements

We gratefully acknowledge the members of our institution for the data collection and the recruitment of the study participants.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Hiratsuka City Hospital, Hiratsuka, Japan

    Shungo Goto, Kota Takahashi, Naoki Ohkubo, Nobuyoshi Kawamura, Tetsuya Tamura, Hisakuni Tomonari, Akito Iwasaki, Leo Taniguchi & Kazuhiro Atsukawa

  2. Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan

    Jun Arimoto & Hideyuki Chiba

  3. Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Takuma Higurashi & Atsushi Nakajima

  4. Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan

    Yusuke Saigusa

Authors
  1. Shungo Goto
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  2. Jun Arimoto
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Contributions

SG, JA, TH, HC, KA and AN conceived of the study. SG, JA, LT and KA performed the colorectal ESD. SG, KT, NO, NK, TT, HT and AI recruited the study participants. YS gave advice on the statistical analysis methods and the interpretation of the data. The analysis and interpretation of the data was conducted by SG, JA, TH and YS. All the authors have read the final manuscript and approved its submission for publication.

Corresponding author

Correspondence to Atsushi Nakajima.

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Disclosures

Shungo Goto, Jun Arimoto, Takuma Higurashi, Kota Takahashi, Naoki Ohkubo, Nobuyoshi Kawamura, Tetsuya Tamura, Hisakuni Tomonari, Akito Iwasaki, Leo Taniguchi, Hideyuki Chiba, Kazuhiro Atsukawa, Yusuke Saigusa, and Atsushi Nakajima have no conflicts of interest or financial ties to disclose.

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Goto, S., Arimoto, J., Higurashi, T. et al. Efficacy and safety of colorectal endoscopic submucosal dissection in patients with sarcopenia. Surg Endosc 35, 5489–5496 (2021). https://doi.org/10.1007/s00464-020-08041-1

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  • DOI: https://doi.org/10.1007/s00464-020-08041-1

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