Treatment strategy for local recurrences after endoscopic resection of a colorectal neoplasm
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Background and Aim
Endoscopic salvage treatment for recurrent or residual neoplasms is sometimes technically challenging, and information in choice of treatment methods is lacking. This study aimed to clarify the appropriate treatment strategy for local recurrence after endoscopic resection (ER).
Seventy-four patients with 74 lesions who received endoscopic treatment for local recurrence after ER for colorectal epithelial neoplasms between January 2010 and December 2016 were enrolled. Patients with hyperplastic polyp, sessile-serrated adenoma/polyp, and submucosal invasive cancer in their initial ER were excluded. Treatment methods, treatment outcomes, and recurrence rate were evaluated for each recurrence based on the preoperative endoscopic diagnosis (adenomatous or cancerous).
Forty-nine of the 74 patients diagnosed with adenomatous recurrence were treated using cold polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD) in 15, 26, and 8 patients, respectively. Cold polypectomy was applied only to diminutive lesions. EMR and ESD en bloc resection rates were 53.8 and 100%, respectively (p = 0.030). Two patients (7.7%) in the EMR group developed local recurrence, but an additional ER achieved complete resection. Meanwhile, the remaining 25 patients diagnosed with cancerous recurrence were treated via EMR and ESD for 7 and 18 patients, respectively. EMR and ESD en bloc resection rates were 28.6 and 83.3%, respectively (p = 0.017). Three patients (42.9%) in the EMR group developed recurrence.
Selecting appropriate treatment methods for adenomatous recurrence could be decided based on estimated pathology and lesion size. ESD was effective for cancerous recurrence to achieve complete disease control.
KeywordsCold polypectomy Colorectal neoplasm Endoscopic mucosal resection Endoscopic submucosal dissection Local recurrence
We thank all members of the Division of Endoscopy, Shizuoka Cancer Center, for help rendered with this study.
Compliance with ethical standards
Sayo Ito, Kinichi Hotta, Kenichiro Imai, Yuichiro Yamaguchi, Yoshihiro Kishida, Kohei Takizawa, Naomi Kakushima, Noboru Kawata, Masao Yoshida, Hirotoshi Ishiwatari, Hiroyuki Matsubayashi, and Hiroyuki Ono have no conflicts of interest or financial ties to disclose.
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