Abstract
Background
Transanal local excision (LE) is a well-established treatment option for early rectal neoplasms not amenable to complete colonoscopic removal. Endoscopic submucosal dissection (ESD) has been introduced recently as a novel procedure that enables en bloc resection of large rectal neoplasms. To date, no report comparing the two approaches can be found in the literature. This study aimed to compare the short-term clinical outcomes between ESD and LE for early rectal neoplasms.
Methods
Between 2007 and 2010, 14 patients with early rectal neoplasms deemed not feasible for en bloc endoscopic resection using conventional techniques underwent ESD. They were compared with a matched cohort of 30 patients who had early rectal neoplasms and underwent LE between 2000 and 2009. Short-term clinical outcomes including postprocedure recovery and morbidity were compared between the two groups.
Results
The mean lesion size was comparable between the ESD and LE groups (2.9 vs 2.6 cm; P = 0.423), but the mean distance of the lesions from the anal verge was greater in the ESD group (8.6 vs 5.0 cm; P = 0.001). En bloc resection was achieved for 12 patients (85.7%) in the ESD group and for all the patients in the LE group. The ESD group exhibited a trend toward a longer operative time (77.5 vs 50.0 min; P = 0.081) but lower morbidity (7.1 vs 33.3%; P = 0.076). The time to full ambulation was shorter in the ESD group (0 vs 1 day; P = 0.005), but the hospital stay was similar in the two groups (2.5 vs 4.0 days; P = 0.129).
Conclusion
For the treatment of early rectal neoplasms, ESD offers better short-term clinical outcomes in terms of faster recovery and possibly lower morbidity than LE. Further prospective studies with a larger sample are needed to validate the benefits of rectal ESD.
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References
Rim SH, Seeff L, Ahmed F, King JB, Coughlin SS (2009) Colorectal cancer incidence in the United States, 1999–2004 : an updated analysis of data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results Program. Cancer 115:1967–1976
Hyodo I, Suzuki H, Takahashi K, Saito Y, Tanaka S, Chiu HM, Kim NK, Li J, Lim R, Villalon A, Boku N (2010) Present status and perspectives of colorectal cancer in Asia: Colorectal Cancer Working Group report in 30th Asia-Pacific Cancer Conference. Jpn J Clin Oncol 40(Suppl 1):i38–i43
Zavoral M, Suchanek S, Zavada F, Dusek L, Muzik J, Seifert B, Fric P (2009) Colorectal cancer screening in Europe. World J Gastroenterol 15:5907–5915
Hurlstone DP, Cross SS, Adam I, Shorthouse AJ, Brown S, Sanders DS, Lobo AJ (2004) Efficacy of high magnification chromoscopic colonoscopy for the diagnosis of neoplasia in flat and depressed lesions of the colorectum: a prospective analysis. Gut 53:284–290
Middleton PF, Sutherland Lm, Maddern GJ (2005) Transanal endoscopic microsurgery: a systemic review. Dis Col Rectum 48:270–284
McCloud JM, Waymont N, Pahwa N, Varghese P, Richards C, Jameson JS, Scott AND (2006) Factors predicting early recurrence after transanal endoscopic microsurgery excision for rectal adenoma. Colorect Dis 8:581–585
Casadesus D (2009) Surgical resection of rectal adenoma: a rapid review. World J Gastroenterol 15:3851–3854
Pigot F, Bouchard D, Mortaji M, Castinel A, Juguet F, Chaume JC, Faivre J (2003) Local excision of large rectal villous adenomas: long-term results. Dis Colon Rectum 46:1345–1350
Featherstone JM, Grabham JA, Fozard JB (2004) Per-anal excision of large, rectal, villous adenomas. Dis Colon Rectum 47:86–89
Tanaka S, Oka S, Chayama K (2008) Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection. J Gastroenterol 43:641–651
Saito Y, Fukuzawa M, Matsuda T, Fukunaga S, Sakamota 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
Yoshida N, Wakabayashil N, Kanemasa K (2009) Endoscopic submucosal dissection for colorectal tumors: technical difficulties and rate of perforation. Endoscopy 41:758–761
Tanaka S, Oka S, Kaneko I, Hirata M, Mouri R, Kanao H, Yoshida S, Chayama K (2007) Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc 66:100–107
Hon SS, Philip CW, Li JC, Lo AW, Ng SS (2010) Endoscopic submucosal dissection of a broad-based rectal polyp (video demonstration). Surg Pract 14:75–76
Buess G, Hutter F, Theiss J, Bobel M, Isslhard W, Pichlmaier H (1984) Das Syste fur die transanale endoskopische Rectumoperation. Chirurg 55:677–680
Guerrieri M, Baldarelli M, de Sanctis A, Campagnacci R, Rimini M, Lezoche E (2010) Treatment of rectal adenomas by transanal endoscopic microsurgery: 15 years’ experience. Surg Endosc 24:445–449
Yoshida N, Yagi N, Naito Y, Yoshikawa T (2010) Safe procedure in endoscopic submucosal dissection for colorectal tumors focused on preventing complications. World J Gastroenterol 16:1688–1695
Deprez PH, Bergman JJ, Meisner S, Ponchon T, Repici A, Dinis-Ribeiro M, Haringsma J (2010) Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts. Endoscopy 42:853–858
Darrah DM, Griebling TL, Silverstein JH (2009) Postoperative urinary retention. Anesthesiol Clin 27:465–484
Baldini G, Bagry H, Aprikian A, Carli F (2009) Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology 110:1139–1157
Disclosures
Sophie S. F. Hon, Simon S. M. Ng, Philip W. Y. Chiu, Francis K. L. Chan, Enders K. W. Ng, Jimmy C. M. Li, Janet F. Y. Lee, and K. L. Leung have no conflicts of interest or financial ties to disclose.
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Hon, S.S.F., Ng, S.S.M., Chiu, P.W.Y. et al. Endoscopic submucosal dissection versus local excision for early rectal neoplasms: a comparative study. Surg Endosc 25, 3923–3927 (2011). https://doi.org/10.1007/s00464-011-1821-z
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DOI: https://doi.org/10.1007/s00464-011-1821-z