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Endoscopic submucosal dissection for laterally spreading tumors in the rectum ≥40 mm

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Abstract

Background

Endoscopic submucosal dissection (ESD) has been developed to allow en bloc resection of early neoplasia of the gastrointestinal tract, including colorectal tumors. The aim of the present study was to evaluate the safety and efficacy of ESD for laterally spreading tumors (LSTs) in the rectum with diameters of 40 mm or more.

Methods

Between January 2010 and October 2014, 35 patients with a total of 36 LSTs of the rectum measuring ≥40 mm were included in this study. Clinical and pathological characteristics and clinical outcomes were examined and analyzed.

Results

The mean operating time was 125.8 ± 61.4 min, and the mean size of the tumors was 59.4 ± 19.8 mm. The rate of en bloc resection and en bloc R0 resection were 91.7 % (33/36) and 88.9 % (32/36), respectively. Perforation occurred in three patients (8.6 %) and was managed conservatively. Postoperative bleeding occurred in one patient (2.9 %) and was treated by endoscopic hemostasis. Excluding five patients, who either underwent additional surgery (n = 1) or were lost to follow-up (n = 4), two patients in our cohort (6.7 %) presented with recurrence of a small adenoma. The remaining patients (n = 28) were free of recurrence during a mean follow-up period of 18.7 ± 4.2 months (range 12–43 months).

Conclusions

Our results indicated that ESD is an effective and safe therapeutic option with high curative rates for LSTs in the rectum ≥40 mm. To prove its long-term efficacy, a large multicenter prospective study is required.

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Acknowledgments

This study was supported by the grant from the National Natural Science Foundation of China (No. 81101610), Scientific Research Projects of Guangdong Province (No. 2013B021800311) and Medical Research Foundation of Guangdong Province (No. WSTJJ2011110142092192119760913465X).

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    Authors and Affiliations

    1. Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, No.1838, Guangzhou North Ave, Guangzhou, 510515, China

      X. W. Tang, J. Q. Zhou, Z. Y. Chen, B. Jiang & W. Gong

    2. Departmemt of Gastroenterology, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, Dongxiaokou Town, Changping District, Beijing, China

      X. W. Tang, Y. T. Ren, J. Q. Zhou, Z. J. Wei & B. Jiang

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    1. X. W. Tang
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    Correspondence to W. Gong.

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    The authors declare that they have no conflict of interest.

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    The study, a retrospective data collection, didn’t need any approval by the local ethics committee.

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    Authors declare informed consent was obtained from the participant included in the study.

    Additional information

    X. W. Tang, Y. T. Ren and J. Q. Zhou have equally contributed to this work.

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    Tang, X.W., Ren, Y.T., Zhou, J.Q. et al. Endoscopic submucosal dissection for laterally spreading tumors in the rectum ≥40 mm. Tech Coloproctol 20, 437–443 (2016). https://doi.org/10.1007/s10151-016-1459-x

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