Skip to main content

Advertisement

SpringerLink
Log in

Clinical outcomes of endoscopic resection for colorectal laterally spreading tumors with advanced histology

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Colorectal laterally spreading tumors (LSTs) are large, flat neoplasms that are usually treated using different endoscopic techniques based on their morphology, size, and histology. The aim of this study was to evaluate the clinical outcomes of LSTs with advanced histology treated by endoscopic resection.

Methods

A total of 246 LSTs with advanced histology [i.e., high-grade dysplasia (HGD) and adenocarcinoma (AC)] treated by endoscopic resection [i.e., endoscopic mucosal resection (EMR), EMR-precutting (EMR-P), and endoscopic submucosal dissection (ESD)] were enrolled. Clinicopathological characteristics were collected by review of patient’s medical records.

Results

The en bloc resection and R0 resection rates were 75.6% and 85.0%, respectively. The bleeding and perforation rates were 10.2% and 2.4%, respectively. The frequency of cancerous pit pattern and bleeding was significantly higher in LSTs with AC than in LSTs with HGD. The R0 resection rate in LSTs with HGD was significantly higher than that in LSTs with AC. The frequency of cancerous pit patterns in LST cases with submucosal AC was significantly higher than those with intramucosal AC. The mean size of the LSTs was significantly larger in ESD group than in EMR or EMR-P groups. The frequencies of nodular mixed subtype, cancerous pit patterns, and en bloc resection rates were significantly higher in the ESD group than in the EMR or EMR-P groups. However, the frequency of perforation was significantly higher in EMR-P group than in EMR or ESD groups.

Conclusions

These results indicate that ESD is a more acceptable treatment approach for resection of colorectal LSTs of larger size, with nodular mixed subtype, having a cancerous pit pattern or AC, using either en bloc or curative resection methods, compared to EMR or EMR-P procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. De Ceglie A, Hassan C, Mangiavillano B, Matsuda T, Saito Y, Ridola L, Bhandari P, Boeri F, Conio M (2016) Endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions: a systematic review. Crit Rev Oncol Hematol 104:138–155

    Article  PubMed  Google Scholar 

  2. Saunders BP, Tsiamoulos ZP (2016) Endoscopic mucosal resection and endoscopic submucosal dissection of large colonic polyps. Nat Rev Gastroenterol Hepatol 13:486–496

    Article  PubMed  Google Scholar 

  3. Tanaka S, Kashida H, Saito Y, Yahagi N, Yamano H, Saito S, Hisabe T, Yao T, Watanabe M, Yoshida M, Kudo SE, Tsuruta O, Sugihara K, Watanabe T, Saitoh Y, Igarashi M, Toyonaga T, Ajioka Y, Ichinose M, Matsui T, Sugita A, Sugano K, Fujimoto K, Tajiri H (2015) JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 27:417–434

    Article  PubMed  Google Scholar 

  4. Ma MX, Bourke MJ (2016) Complications of endoscopic polypectomy, endoscopic mucosal resection and endoscopic submucosal dissection in the colon. Best Pract Res Clin Gastroenterol 30:749–767

    Article  PubMed  Google Scholar 

  5. Lambert R, Tanaka S (2012) Laterally spreading tumors in the colon and rectum. Eur J Gastroenterol Hepatol 24:1123–1134

    Article  PubMed  Google Scholar 

  6. Facciorusso A, Antonino M, Di Maso M, Barone M, Muscatiello N (2015) Non-polypoid colorectal neoplasms: classification, therapy and follow-up. World J Gastroenterol 21:5149–5157

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kim BC, Chang HJ, Han KS, Sohn DK, Hong CW, Park JW, Park SC, Choi HS, Oh JH (2011) Clinicopathological differences of laterally spreading tumors of the colorectum according to gross appearance. Endoscopy 43:100–107

    Article  CAS  PubMed  Google Scholar 

  8. Rotondano G, Bianco MA, Buffoli F, Gizzi G, Tessari F, Cipolletta L (2011) The Cooperative Italian FLIN Study Group: prevalence and clinico-pathological features of colorectal laterally spreading tumors. Endoscopy 43:856–861

    Article  CAS  PubMed  Google Scholar 

  9. Kim KO, Jang BI, Jang WJ, Lee SH (2013) Laterally spreading tumors of the colorectum: clinicopathologic features and malignant potential by macroscopic morphology. Int J Colorectal Dis 28:1661–1666

    Article  CAS  PubMed  Google Scholar 

  10. Zhao X, Zhan Q, Xiang L, Wang Y, Wang X, Li A, Liu S (2014) Clinicopathological characteristics of laterally spreading colorectal tumor. PLoS ONE 9:e94552

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Kaku E, Oda Y, Murakami Y, Goto H, Tanaka T, Hasuda K, Yasunaga M, Ito K, Sakurai K, Fujimori T, Hattori M, Sasaki Y (2011) Proportion of flat- and depressed-type and laterally spreading tumor among advanced colorectal neoplasia. Clin Gastroenterol Hepatol 9:503–508

    Article  PubMed  Google Scholar 

  12. Kudo SE, Takemura O, Ohtsuka K (2008) Flat and depressed types of early colorectal cancers: from East to West. Gastrointest Endosc Clin N Am 18:581–593

    Article  PubMed  Google Scholar 

  13. Oka S, Tanaka S, Kanao H, Oba S, Chayama K (2009) Therapeutic strategy for colorectal laterally spreading tumor. Dig Endosc 21(Suppl 1):S43–S46

    Article  PubMed  Google Scholar 

  14. Uraoka T, Saito Y, Matsuda T, Ikehara H, Gotoda T, Saito D, Fujii T (2006) Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut 55:1592–1597

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Huang Y, Liu S, Gong W, Zhi F, Pan D, Jiang B (2009) Clinicopathologic features and endoscopic mucosal resection of laterally spreading tumors: experience from China. Int J Colorectal Dis 24:1441–1450

    Article  PubMed  Google Scholar 

  16. Saito Y, Fukuzawa M, Matsuda T, Fukunaga S, Sakamoto T, Uraoka T, Nakajima T, Ikehara H, Fu KI, Itoi T, Fujii T (2010) Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 24:343–352

    Article  PubMed  Google Scholar 

  17. Xu MD, Wang XY, Li QL, Zhou PH, Zhang YQ, Zhong YS, Chen WF, Ma LL, Qin WZ, Hu JW, Yao LQ (2013) Colorectal lateral spreading tumor subtypes: clinicopathology and outcome of endoscopic submucosal dissection. Int J Colorectal Dis 28:63–72

    Article  PubMed  Google Scholar 

  18. Cong ZJ, Hu LH, Ji JT, Xing JJ, Shan YQ, Li ZS, Yu ED (2016) A long-term follow-up study on the prognosis of endoscopic submucosal dissection for colorectal laterally spreading tumors. Gastrointest Endosc 83:800–807

    Article  PubMed  Google Scholar 

  19. Terasaki M, Tanaka S, Oka S, Nakadoi K, Takata S, Kanao H, Yoshida S, Chayama K (2012) Clinical outcomes of endoscopic submucosal dissection and endoscopic mucosal resection for laterally spreading tumors larger than 20 mm. J Gastroenterol Hepatol 27:734–740

    Article  PubMed  Google Scholar 

  20. Nishiyama H, Isomoto H, Yamaguchi N, Ishii H, Fukuda E, Machida H, Nakamura T, Ohnita K, Shikuwa S, Kohno S, Nakao K (2010) Endoscopic submucosal dissection for laterally spreading tumours of the colorectum in 200 consecutive cases. Surg Endosc 24:2881–2887

    Article  PubMed  Google Scholar 

  21. Kudo S, Rubio CA, Teixeira CR, Kashida H, Kogure E (2001) Pit pattern in colorectal neoplasia: endoscopic magnifying view. Endoscopy 33:367–373

    Article  CAS  PubMed  Google Scholar 

  22. Hamilton SR, Aaltonen LA (2000) Pathology and genetics of tumours of the digestive system. World Health Organization Classification of Tumours. IARC Press, Lyon, p 314

    Google Scholar 

  23. Dixon MF (2002) Gastrointestinal epithelial neoplasia: Vienna revised. Gut 51:130–131

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Brenner H, Kloor M, Pox CP (2014) Colorectal cancer. Lancet 383:1490–1502

    Article  PubMed  Google Scholar 

  25. Choi Y, Sateia HF, Peairs KS, Stewart RW (2017) Screening for colorectal cancer. Semin Oncol 44:34–44

    Article  PubMed  Google Scholar 

  26. Mahasneh A, Al-Shaheri F, Jamal E (2017) Molecular biomarkers for an early diagnosis, effective treatment and prognosis of colorectal cancer: current updates. Exp Mol Pathol 102:475–483

    Article  CAS  PubMed  Google Scholar 

  27. Li M, Ali SM, Umm-a-OmarahGilani S, Liu J, Li YQ, Zuo XL (2014) Kudo’s pit pattern classification for colorectal neoplasms: a meta-analysis. World J Gastroenterol 20:12649–12656

    Article  PubMed  PubMed Central  Google Scholar 

  28. Zanoni EC, Cutait R, Averbach M, de Oliveira LA, Teixeira CR, Corrêa PA, Paccos JL, Rossini GF, Lopes LHC (2007) Magnifying colonoscopy: interobserver agreement in the assessment of colonic pit patterns and its correlation with histopathological findings. Int J Colorectal Dis 22:1383–1388

    Article  PubMed  Google Scholar 

  29. Matsuda T, Fujii T, Saito Y, Nakajima T, Uraoka T, Kobayashi N, Ikehara H, Ikematsu H, Fu KI, Emura F, Ono A, Sano Y, Shimoda T, Fujimori T (2008) Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms. Am J Gastroenterol 103:2700–2706

    Article  PubMed  Google Scholar 

  30. Yamada M, Saito Y, Sakamoto T, Nakajima T, Kushima R, Parra-Blanco A, Matsuda T (2016) Endoscopic predictors of deep submucosal invasion in colorectal laterally spreading tumors. Endoscopy 48:456–464

    Article  PubMed  Google Scholar 

  31. Oka S, Uraoka T, Tamai N, Ikematsu H, Chino A, Okamoto K, Takeuchi Y, Imai K, Ohata K, Shiga H, Raftopoulos S, Lee BI, Matsuda T (2017) Standardization of endoscopic resection for colorectal tumors larger than 10 mm in diameter. Dig Endosc 29(Suppl 2):40–44

    Article  PubMed  Google Scholar 

  32. Kim TJ, Kim ER, Hong SN, Kim YH, Chang DK (2017) Current practices in endoscopic submucosal dissection for colorectal neoplasms: a survey of indications among Korean endoscopists. Intest Res 15:228–235

    Article  PubMed  PubMed Central  Google Scholar 

  33. Lee EJ, Lee JB, Lee SH, Youk EG (2012) Endoscopic treatment of large colorectal tumors: comparison of endoscopic mucosal resection, endoscopic mucosal resection-precutting, and endoscopic submucosal dissection. Surg Endosc 26:2220–2230

    Article  PubMed  Google Scholar 

  34. Kim MN, Kang JM, Yang JI, Kim BK, Im JP, Kim SG, Jung HC, Song IS, Kim JS (2011) Clinical features and prognosis of early colorectal cancer treated by endoscopic mucosal resection. J Gastroenterol Hepatol 26:1619–1625

    Article  PubMed  Google Scholar 

  35. Yasuda K, Inomata M, Shiromizu A, Shiraishi N, Higashi H, Kitano S (2007) Risk factors for occult lymph node metastasis of colorectal cancer invading the submucosa and indications for endoscopic mucosal resection. Dis Colon Rectum 50:1370–1376

    Article  PubMed  Google Scholar 

  36. Lambert R, Kudo SE, Vieth M, Allen JI, Fujii H, Fujii T, Kashida H, Matsuda T, Mori M, Saito H, Shimoda T, Tanaka S, Watanabe H, Sung JJ, Feld AD, Inadomi JM, O’Brien MJ, Lieberman DA, Ransohoff DF, Soetikno RM, Zauber A, Teixeira CR, Rey JF, Jaramillo E, Rubio CA, Van Gossum A, Jung M, Jass JR, Triadafilopoulos G (2009) Pragmatic classification of superficial neoplastic colorectal lesions. Gastrointest Endosc 70:1182–1199

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, South Korea

    Jin-Sung Jung, Ji-Yun Hong, Hyung-Hoon Oh, Hyun-Soo Kim & Young-Eun Joo

  2. Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea

    Sun-Seog Kweon

  3. Department of Internal Medicine, Chosun University College of Medicine, Gwangju, South Korea

    Jun Lee

  4. Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, South Korea

    Sang-Wook Kim

  5. Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, South Korea

    Geom-Seog Seo

Authors
  1. Jin-Sung Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ji-Yun Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hyung-Hoon Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sun-Seog Kweon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sang-Wook Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Geom-Seog Seo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hyun-Soo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Young-Eun Joo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Young-Eun Joo.

Ethics declarations

Disclosures

Jin-Sung Jung, Ji-Yun Hong, Hyung-Hoon Oh, Sun-Seog Kweon, Jun Lee, Sang-Wook Kim, Geom-Seog Seo, Hyun-Soo Kim, and Young-Eun Joo have no conflicts of interest or financial ties to disclose.

Additional information

Jin-Sung Jung and Ji-Yun Hong have contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jung, JS., Hong, JY., Oh, HH. et al. Clinical outcomes of endoscopic resection for colorectal laterally spreading tumors with advanced histology. Surg Endosc 33, 2562–2571 (2019). https://doi.org/10.1007/s00464-018-6550-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6550-0

Keywords

Search

Navigation