Surgical Endoscopy

, Volume 24, Issue 2, pp 343–352

Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection

  • Yutaka Saito
  • Masakatsu Fukuzawa
  • Takahisa Matsuda
  • Shusei Fukunaga
  • Taku Sakamoto
  • Toshio Uraoka
  • Takeshi Nakajima
  • Hisatomo Ikehara
  • Kuang-I Fu
  • Takao Itoi
  • Takahiro Fujii
Article

DOI: 10.1007/s00464-009-0562-8

Cite this article as:
Saito, Y., Fukuzawa, M., Matsuda, T. et al. Surg Endosc (2010) 24: 343. doi:10.1007/s00464-009-0562-8

Abstract

Background and Aims

Endoscopic submucosal dissection (ESD) has recently been applied to the treatment of superficial colorectal cancer. Clinical outcomes compared with conventional endoscopic mucosal resection (EMR) have not been determined so our aim was to compare the effectiveness of ESD with conventional EMR for colorectal tumors ≥20 mm.

Methods

This was a retrospective case-controlled study performed at the National Cancer Center Hospital in Tokyo, Japan involving 373 colorectal tumors ≥20 mm determined histologically to be curative resections. Data acquisition was from a prospectively completed database. We evaluated histology, tumor size, procedure time, en bloc resection rate, recurrence rate, and associated complications for both the ESD and EMR groups.

Results

A total of 145 colorectal tumors were treated by ESD and another 228 were treated by EMR. ESD was associated with a longer procedure time (108 ± 71 min/29 ± 25 min; p < 0.0001), higher en bloc resection rate (84%/33%; p < 0.0001) and larger resected specimens (37 ± 14 mm/28 ± 8 mm; p = 0.0006), but involved a similar percentage of cancers (69%/66%; p = NS). There were three (2%) recurrences in the ESD group and 33 (14%) in the EMR group requiring additional EMR (p < 0.0001). The perforation rate was 6.2% (9) in the ESD group and 1.3% (3) in the EMR group (p = NS) with delayed bleeding occurring in 1.4% (2) and 3.1% (7) of the procedures (p = NS), respectively, as all complications were effectively treated endoscopically.

Conclusions

Despite its longer procedure time and higher perforation rate, ESD resulted in higher en bloc resection and curative rates compared with EMR and all ESD perforations were successfully managed by conservative endoscopic treatment.

Keywords

Endoscopic submucosal dissection (ESD)Endoscopic mucosal resection (EMR)RecurrenceColonColorectalShort-term clinical outcome

Abbreviations

B-knife

Bipolar needle knife

CO2

Carbon dioxide

EMR

Endoscopic mucosal resection

EPMR

Endoscopic piecemeal mucosal resection

ESD

Endoscopic submucosal dissection

IT knife

Insulation-tipped knife

LN

Lymph node

sm

Submucosal

LST

Laterally spreading tumor

LST-G

Laterally spreading tumor granular type

LST-NG

Laterally spreading tumor nongranular type

NS

Not significant

SD

Standard deviation

sm1

Minute submucosal cancer

sm2

Submucosal deep cancer

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Yutaka Saito
    • 1
  • Masakatsu Fukuzawa
    • 1
    • 2
  • Takahisa Matsuda
    • 1
  • Shusei Fukunaga
    • 1
  • Taku Sakamoto
    • 1
  • Toshio Uraoka
    • 1
    • 3
  • Takeshi Nakajima
    • 1
  • Hisatomo Ikehara
    • 1
    • 4
  • Kuang-I Fu
    • 1
    • 5
  • Takao Itoi
    • 1
    • 2
  • Takahiro Fujii
    • 1
    • 6
  1. 1.Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
  2. 2.Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
  3. 3.Department of EndoscopyOkayama University HospitalOkayamaJapan
  4. 4.Endoscopy and Gastrointestinal OncologyShizuoka Cancer CenterShizuokaJapan
  5. 5.Department of GastroenterologyJuntendou University Nerima HospitalTokyoJapan
  6. 6.Takahiro Fujii ClinicTokyoJapan