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Long-term outcomes of endoscopic treatment for colorectal laterally spreading tumor: a large-scale multicenter retrospective study from China

Surgical Endoscopy volume 35, pages 736–744 (2021)Cite this article

Abstract

Background

Laterally spreading tumor (LST) is a type of precancerous lesion of colorectal cancer with high malignant potential. The present study aimed to evaluate long-term outcomes of endoscopic treatment for LST in Chinese patients.

Methods

This study was a retrospective review of data collected from 653 included patients with LST from six regional representative hospitals in China between January 2007 and January 2017. Demographic characteristics, endoscopic features of LST, operation-related data, and follow-up results were collected and analyzed.

Results

LST-granular type (LST-G, 80.3%) was much more common than LST-non-grandular type (LST-NG, 19.7%). The overall submucosal invasion rate of all LSTs was 6.1% and the submucosal invasion rate of LST-NG was significantly higher than that of LST-G (6.79% vs. 3.87%, p = 0.000). The en bloc resection rate of ESD and EMR treatment was 96% and 93.7%, respectively, with pathologic R0 resection rate of 90.1% and 82.8%. After an average duration of follow-up about 34.52 ± 11.76 months, the recurrence rate of ESD was 3.47%, and the recurrence rate of EMR was 8.8% after an average follow-up of about 38.44 ± 4.42 months. However, the recurrence rate of ESD was much lower than piecemeal EMR for LST (3.47% vs. 8.62%, p = 0.017). Retroflexion-assisted technique applied for resection of rectal LST was associated with a significantly shortened operating time (85.40 min vs. 174.18 min, p = 0.002).

Conclusion

Endoscopic resection is a safe and efficient modality for the treatment of colorectal LST with a relatively low recurrence rate and shortened operating time with the use of retroflexion.

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Fig. 1
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Abbreviations

EMR:

Endoscopic mucosal resection

REMR:

Retroflexion-assisted endoscopic mucosal resection

LSTs:

Laterally spreading tumors

APC:

Argon plasma coagulation

References

  1. Ahlenstiel G, Hourigan LF, Brown G, Zanati S, Williams SJ, Singh R, Moss A, Sonson R, Bourke MJ (2014) Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon. Gastrointest Endosc 80:668–676

    Article  Google Scholar 

  2. Saito Y, Fujii T, Kondo H, Mukai H, Yokota T, Kozu T, Saito D (2001) Endoscopic treatment for laterally spreading tumors in the colon. Endoscopy 33:682–686

    CAS  Article  Google Scholar 

  3. Kudo S (1993) Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 25:455–461

    CAS  Article  Google Scholar 

  4. Kudo S, Lambert R, 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, Triadafilopoulos G, Zauber A, Teixeira CR, Rey JF, Jaramillo E, Rubio CA, Van Gossum A, Jung M, Vieth M, Jass JR, Hurlstone PD (2008) Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc 68:S3–47

    Article  Google Scholar 

  5. Soetikno R, Friedland S, Kaltenbach T, Chayama K, Tanaka S (2006) Nonpolypoid (flat and depressed) colorectal neoplasms. Gastroenterology 130:566–576 (quiz 588–569)

    Article  Google Scholar 

  6. 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  Google Scholar 

  7. Liu S, Li Y, Yang H, Li A, Han Z, Wang X, Xiong F, Xu W, Zhou D (2016) Retroflexion-assisted endoscopic mucosal resection: a useful and safe method for removal of low rectal laterally spreading tumors. Surg Endosc 30:139–146

    Article  Google Scholar 

  8. Toyonaga T, Man-i M, Fujita T, East JE, Nishino E, Ono W, Morita Y, Sanuki T, Yoshida M, Kutsumi H, Inokuchi H, Azuma T (2010) Retrospective study of technical aspects and complications of endoscopic submucosal dissection for laterally spreading tumors of the colorectum. Endoscopy 42:714–722

    CAS  Article  Google Scholar 

  9. Hayashi Y, Shinozaki S, Sunada K, Sato H, Miura Y, Ino Y, Horie H, Fukushima N, Lefor AK, Yamamoto H (2016) Efficacy and safety of endoscopic submucosal dissection for superficial colorectal tumors more than 50 mm in diameter. Gastrointest Endosc 83:602–607

    Article  Google Scholar 

  10. Oka S, Tanaka S, Saito Y, Iishi H, Kudo SE, Ikematsu H, Igarashi M, Saitoh Y, Inoue Y, Kobayashi K, Hisabe T, Tsuruta O, Sano Y, Yamano H, Shimizu S, Yahagi N, Watanabe T, Nakamura H, Fujii T, Ishikawa H, Sugihara K (2015) Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan. Am J Gastroenterol 110:697–707

    Article  Google Scholar 

  11. Huang Q, Fukami N, Kashida H, Takeuchi T, Kogure E, Kurahashi T, Stahl E, Kudo Y, Kimata H, Kudo SE (2004) Interobserver and intra-observer consistency in the endoscopic assessment of colonic pit patterns. Gastrointest Endosc 60:520–526

    Article  Google Scholar 

  12. Uraoka T, Saito Y, Ikematsu H, Yamamoto K, Sano Y (2011) Sano's capillary pattern classification for narrow-band imaging of early colorectal lesions. Dig Endosc 23:112–115

    Article  Google Scholar 

  13. Klein A, Bourke MJ (2017) How to perform high-quality endoscopic mucosal resection during colonoscopy. Gastroenterology 152:466–471

    Article  Google Scholar 

  14. Ferlitsch M, Moss A, Hassan C, Bhandari P, Dumonceau JM, Paspatis G, Jover R, Langner C, Bronzwaer M, Nalankilli K, Fockens P, Hazzan R, Gralnek IM, Gschwantler M, Waldmann E, Jeschek P, Penz D, Heresbach D, Moons L, Lemmers A, Paraskeva K, Pohl J, Ponchon T, Regula J, Repici A, Rutter MD, Burgess NG, Bourke MJ (2017) Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 49:270–297

    Article  Google Scholar 

  15. Lee EY, Bourke MJ (2016) EMR should be the first-line treatment for large laterally spreading colorectal lesions. Gastrointest Endosc 84:326–328

    Article  Google Scholar 

  16. Osera S, Ikematsu H, Fujii S, Hori K, Oono Y, Yano T, Kaneko K (2017) Endoscopic treatment outcomes of laterally spreading tumors with a skirt (with video). Gastrointest Endosc 86:533–541

    Article  Google Scholar 

  17. Belderbos TD, Leenders M, Moons LM, Siersema PD (2014) Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy 46:388–402

    Article  Google Scholar 

  18. Sakamoto T, Matsuda T, Otake Y, Nakajima T, Saito Y (2012) Predictive factors of local recurrence after endoscopic piecemeal mucosal resection. J Gastroenterol 47:635–640

    Article  Google Scholar 

  19. Mannath J, Subramanian V, Singh R, Telakis E, Ragunath K (2011) Polyp recurrence after endoscopic mucosal resection of sessile and flat colonic adenomas. Dig Dis Sci 56:2389–2395

    CAS  Article  Google Scholar 

Download references

Acknowledgements

We want to express our gratitude to the Science and Technology Planning Project of Guangdong Province (2017A020215139). Guangdong gastrointestinal disease research center (No. 2017B020209003).

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Author notes

  1. Yue Li and Yue Zhang contributed equally to this paper.

Affiliations

  1. Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China

    Yue Li, Yue Zhang, Yusi Wang, Qiang Zhang, Fachao Zhi & Side Liu

  2. Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Yue Li, Fayad Lea & Vivek Kumbhari

  3. Department of Gastroenterology, Southwest Hospital, Army Medical University, Chongqing, 400038, China

    Yao Chen & Guiyong Peng

  4. Department of Endoscopy, Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Beijing, 100021, China

    Lizhou Dou & Guiqi Wang

  5. Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China

    Xianfei Wang

  6. Department of Gastroenterology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, 214023, China

    Qiang Zhan & Guoqiang Zhang

  7. Department of Gastroenterology, The Second Affiliated Hospital, Guangxi Medical University, Nanning, 530000, China

    Mengbin Qin & Jiean Huang

  8. Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China

    Side Liu

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  1. Yue Li
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Contributions

SL and YL designed the study. SL, JH, QZ, FZ, GP, GW performed some cases. YZ, YW, YC, LD, XW, QZ, GZ, and MQ recorded the data. YL and YZ analyzed the data and drafted the manuscript. FL and KV revised the manuscript. All authors have read and approved the submitted version of the paper.

Corresponding author

Correspondence to Side Liu.

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Disclosure

Yue Li, Yue Zhang, Yao Chen, Yusi Wang, Lizhou Dou, Xianfei Wang, Qiang Zhan, Guoqiang Zhang, Mengbin Qin, Fayad Lea, Jiean Huang, Qiang Zhang, Fachao Zhi, Guiyong Peng, Guiqi Wang, Vivek Kumbhari, Side Liu have no conflicts of interest or financial ties to disclose.

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Li, Y., Zhang, Y., Chen, Y. et al. Long-term outcomes of endoscopic treatment for colorectal laterally spreading tumor: a large-scale multicenter retrospective study from China. Surg Endosc 35, 736–744 (2021). https://doi.org/10.1007/s00464-020-07440-8

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  • DOI: https://doi.org/10.1007/s00464-020-07440-8

Keywords

  • Laterally spreading tumor (LST)
  • Endoscopic treatment
  • Long-term outcomes