Local recurrence after endoscopic resection of colorectal tumors

  • Kinichi HottaEmail author
  • Takahiro Fujii
  • Yutaka Saito
  • Takahisa Matsuda
Original Article


Background and aims

Local recurrence frequently occurs after endoscopic resection of large colorectal tumors. However, appropriate intervals for surveillance colonoscopy to assess local recurrence after endoscopic resection have not been clarified. The aim of the present study was to determine local recurrence rates following en-bloc and piecemeal endoscopic resection and establish appropriate surveillance colonoscopy intervals based on retrospective analysis of local recurrences.

Materials and methods

A total of 461 patients with 572 ≥ 10-mm lesions underwent endoscopic resection and follow-up. We retrospectively compared local recurrence rates on lesion size, macroscopic type, and histological type after en-bloc resection (440 lesions) and piecemeal resection (132 lesions). Cumulative local recurrence rates were analyzed using the Kaplan–Meier method.


Local recurrence occurred for 34 lesions (5.9%). Local recurrence rates for the en-bloc and piecemeal groups was 0.7% (3/440) and 23.5% (31/132), respectively (P < 0.001). The difference between the two groups was distinct in terms of lesion size, macroscopic type, and histological type. Of the 34 local recurrences, 32 were treated endoscopically and two cases required additional surgery. The 6-, 12-, and 24-month cumulative local recurrence rate of the en-bloc group was 0.24%, 0.49%, and 0.81%. Then the 6-, 12-, and 24-month cumulative local recurrence rate for the piecemeal group was 18.4%, 23.1%, and 30.7%.


Local recurrence occurred more frequently after piecemeal resection than en-bloc resection. However, almost all cases of local recurrences could be cured by additional endoscopic resection, so piecemeal resection can be acceptable treatment.


Colorectal tumors Colonoscopy Neoplasm recurrence Follow-up studies 



The authors have no commercial associations that might be a conflict of interest in relation to this article.


  1. 1.
    Nivatvongs S, Snover DC, Fang DT (1984) Piecemeal snare excision of large sessile colon and rectal polyps: is it adequate? Gastrointest Endosc 30:18–20PubMedCrossRefGoogle Scholar
  2. 2.
    Walsh RM, Ackroyd FW, Shellito PC (1992) Endoscopic resection of large sessile colorectal polyps. Gastrointest Endosc 38:303–309PubMedCrossRefGoogle Scholar
  3. 3.
    Hintze RE, Adler A, Veltzke W (1995) Endoscopic resection of large colorectal adenomas: a combination of snare and laser ablation. Endoscopy 27:665–670PubMedCrossRefGoogle Scholar
  4. 4.
    Zlatanic J, Waye JD, Kim PS, Baiocco PJ, Gleim GW (1999) Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal snare polypectomy. Gastrointest Endosc 49:731–735PubMedCrossRefGoogle Scholar
  5. 5.
    Brooker JC, Saunders BP, Shah SG, Thapar CJ, Suzuki N, Williams CB (2002) Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations. Gastrointest Endosc 55:371–375PubMedCrossRefGoogle Scholar
  6. 6.
    Waye JD (2001) Endoscopic mucosal resection of colon polyps. Gastrointest Endosc Clin N Am 11:537–548PubMedGoogle Scholar
  7. 7.
    Winawer SJ, Zauber AG, O’brien MJ (1993) Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. N Engl J Med 328:901–906PubMedCrossRefGoogle Scholar
  8. 8.
    Fujii T, Hasegawa RT, Saitoh Y (2001) Chromoscopy during colonoscopy. Endoscopy 33:1036–1041PubMedGoogle Scholar
  9. 9.
    Wolff WI, Shinya H (1973) Polypectomy via the fiberoptic colonoscopy. N Engl J Med 288:329–332PubMedGoogle Scholar
  10. 10.
    Christie JP (1977) Colonoscopic excision of large sessile polyps. Am J Gastroenterol 67:430–438PubMedGoogle Scholar
  11. 11.
    Karita M, Tada M, Okita K (1992) The successive strip biopsy partial resection technique for large early gastric and colon cancers. Gastrointest Endosc 38:174–178PubMedCrossRefGoogle Scholar
  12. 12.
    Kudo S (1993) Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 25:455–461PubMedCrossRefGoogle Scholar
  13. 13.
    Yokota T, Sugihara K, Yoshida S (1994) Endoscopic mucosal resection for colorectal neoplastic lesions. Dis Colon Rectum 37:1108–1111PubMedCrossRefGoogle Scholar
  14. 14.
    Bedogni G, Bertoni G, Ricci E (1986) Colonoscopic excision of large and giant colorectal polyps. Technical implications and results over eight years. Dis Colon Rectum 29:831–835PubMedCrossRefGoogle Scholar
  15. 15.
    Palma GD, Caiazzo C, Matteo ED, Capalbo G, Catanzano C (1995) Endoscopic treatment of sessile rectal adenomas of Nd:YAG laser therapy and injection-assisted piecemeal polypectomy. Gastrointest Endosc 41:553–556PubMedCrossRefGoogle Scholar
  16. 16.
    Soetikno RM, Gotoda T, Nakanishi Y, Soehendra N (2003) Endoscopic mucosal resection. Gastrointest Endosc 57:567–579PubMedCrossRefGoogle Scholar
  17. 17.
    Iishi H, Tatsuta M, Iseki K (2000) Endoscopic mucosal resection with submucosal saline injection of large sessile colorectal polyps. Gastrointest Endosc 51:697–700PubMedCrossRefGoogle Scholar
  18. 18.
    Casadesus D (2006) Transanal endoscopic microsurgery: a review. Endsocopy 38:418–423CrossRefGoogle Scholar
  19. 19.
    Gotoda T, Kondo H, Ono H (1999) A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases. Gastrointest Endosc 50:560–563PubMedCrossRefGoogle Scholar
  20. 20.
    Yamamoto H, Koiwai H, Yube T (1999) A successful single-step endoscopic resection of a 40 millimeter flat-elevated tumor in the rectum: endoscopic mucosal resection using sodium hyaluronate. Gastrointest Endosc 50:701–704PubMedCrossRefGoogle Scholar
  21. 21.
    Winawer S, Fletcher R, Rex D (2003) Colorectal cancer screening and surveillance: clinical guidelines and rationale. Update based on new evidence. Gastroenterology 124:544–560PubMedCrossRefGoogle Scholar
  22. 22.
    Uraoka T, Fujii T, Saito Y (2005) Effectiveness of glycerol as a submucosal injection for EMR. Gastrointest Endosc 61:736–740PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Kinichi Hotta
    • 1
    • 2
    Email author
  • Takahiro Fujii
    • 1
    • 3
  • Yutaka Saito
    • 1
  • Takahisa Matsuda
    • 1
  1. 1.Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
  2. 2.Department of GastroenterologySaku Central HospitalSakuJapan
  3. 3.TF ClinicTokyoJapan

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