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Surgical Endoscopy

, Volume 30, Issue 10, pp 4425–4431 | Cite as

Endoscopic submucosal dissection for anorectal tumor with hemorrhoids close to the dentate line: a multicenter study of Hiroshima GI Endoscopy Study Group

  • Yuzuru Tamaru
  • Shiro OkaEmail author
  • Shinji Tanaka
  • Yuko Hiraga
  • Masaki Kunihiro
  • Shinji Nagata
  • Akira Furudoi
  • Yuki Ninomiya
  • Naoki Asayama
  • Kenjiro Shigita
  • Soki Nishiyama
  • Nana Hayashi
  • Kazuaki Chayama
Article

Abstract

Background

The lower rectum close to the dentate line has distinct characteristics, making endoscopic submucosal dissection (ESD) of tumors challenging. We assessed clinical outcomes of ESD for such patients with hemorrhoids.

Methods

Sixty-four patients (mean age, 68 years) underwent ESD for anorectal tumors close to the dentate line. We divided patients into those with (Group A, 45 patients) and without hemorrhoids (Group B, 19 patients). We examined en bloc and histological en bloc resection rates, procedure time, complication rates, and postoperative prognosis after ESD.

Results

The mean tumor size was 43 mm. Histologic diagnoses were adenoma (42 %, 27/64), carcinoma in situ (44 %, 28/64), and T1 carcinoma (14 %, 9/64). There was no significant difference in en bloc resection (93 %, 42/45 vs. 95 %, 18/19) or postoperative bleeding rates (16 %, 7/45 vs. 11 %, 2/19) between Groups A and B, respectively. The mean procedural durations were 120 and 124 min, respectively, in Groups A and B. No perforations occurred. There was no significant difference in postoperative anal pain rate between Groups A (18 %, 8/45) and B (16 %, 3/19), and it resolved within a few days in all cases. There was one case of stricture in Group B. Two patients with T1 carcinoma underwent additional surgery, one underwent chemotherapy, and five had no additional treatment. No recurrence occurred during the follow-up period of 38 months.

Conclusions

ESD is safe and effective for anorectal tumors close to the dentate line in patients with hemorrhoids.

Keywords

Endoscopic submucosal dissection Rectal tumor Dentate line Hemorrhoid 

Notes

Acknowledgments

This study was conducted with a Grant-in-Aid from the Japan Agency for Medical Research and Development, AMED (15ck0106102h0102).

Compliance with ethical standards

Disclosures

Yuzuru Tamaru, Shiro Oka, Shinji Tanaka, Yuko Hiraga, Masaki Kunihiro, Shinji Nagata, Akira Furudoi, Yuki Ninomiya, Naoki Asayama, Kenjiro Shigita, Soki Nishiyama, Nana Hayashi, and Kazuaki Chayama have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Yuzuru Tamaru
    • 1
    • 2
  • Shiro Oka
    • 1
    • 2
    Email author
  • Shinji Tanaka
    • 1
    • 2
  • Yuko Hiraga
    • 2
  • Masaki Kunihiro
    • 2
  • Shinji Nagata
    • 2
  • Akira Furudoi
    • 2
  • Yuki Ninomiya
    • 2
    • 3
  • Naoki Asayama
    • 2
    • 3
  • Kenjiro Shigita
    • 2
    • 3
  • Soki Nishiyama
    • 2
    • 3
  • Nana Hayashi
    • 2
    • 3
  • Kazuaki Chayama
    • 3
  1. 1.Department of EndoscopyHiroshima University HospitalHiroshimaJapan
  2. 2.Hiroshima GI Endoscopy Study GroupHiroshimaJapan
  3. 3.Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan

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