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Endoscopic submucosal dissection for laterally spreading tumours of the colorectum in 200 consecutive cases

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Abstract

Background

Colorectal laterally spreading tumours (LSTs) are classified into granular (LST-G) and non-granular (LST-NG) type; each type was sub-grouped into LST-G-H (homogenous) and LST-G-M (nodular mixed) type or LST-NG-F (flat elevated) and LST-NG-FD (pseudodepressed) type, respectively. We assessed the clinicopathological factors associated with clinical outcomes of endoscopic submucosal dissection (ESD) for colorectal LSTs, and conducted follow-up after ESD.

Methods

ESD was performed in 196 patients with 204 LSTs that fulfilled the inclusion criteria for colorectal neoplasms. Clinical outcomes including resectability and curability of ESD and perforation were investigated, and factors related to the outcomes were analysed using logistic regression. One hundred thirty-eight patients received endoscopic follow-up for more than 12 months and metastatic surveys in 79 cases of cancerous LSTs.

Results

The incidence of submucosal cancer was lower in LST-G type. There were no significant differences in outcomes regarding LST macroscopic types. Overall en bloc, complete and curative resection, and perforation rates were 86.8%, 77.5%, 82.8% and 9.8%, respectively. Logistic regression analysis showed higher risk of non-curative resection in LST-G-M than in LST-G-H type. No other factors were associated with outcomes. During median follow-up of 35.5 months, no locally recurrent or metastatic tumours were observed, and overall survival was still 100%.

Conclusions

ESD provides acceptable resectability for colorectal LSTs by facilitating en bloc resection, irrespective of macroscopic types. The relatively long-term outcomes may be excellent, but further evaluation is needed for appropriate treatment strategy for each type of LST.

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Disclosures

Authors Hitoshi Nishiyama, Hajime Isomoto, Naoyuki Yamaguchi, Hiroyuki Ishii, Eiichiro Fukuda, Haruhisa Machida, Takashi Nakamura, Ken Ohnita, Saburo Shikuwa, Shigeru Kohno and Kazuhiko Nakao have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Hitoshi Nishiyama, Hajime Isomoto, Naoyuki Yamaguchi, Hiroyuki Ishii, Ken Ohnita & Kazuhiko Nakao

  2. Department of Endoscopy, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Hajime Isomoto, Naoyuki Yamaguchi & Shigeru Kohno

  3. Internal Medicine, National Nagasaki Medical Center, 2-1001-1 Kubara, Omura, 856-8562, Japan

    Hitoshi Nishiyama & Takashi Nakamura

  4. Internal Medicine, Sasebo Municipal Hospital, 9-3 Hirase, Sasebo, 857-8511, Japan

    Eiichiro Fukuda

  5. Internal Medicine, National Ureshino Medical Center, 2436 Shimojuku, Ureshino, 843-0393, Japan

    Haruhisa Machida

  6. Sankokai Miyazaki Hospital, Kuyama 1575-1, Isahaya, 854-0066, Japan

    Saburo Shikuwa

Authors
  1. Hitoshi Nishiyama
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  2. Hajime Isomoto
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  3. Naoyuki Yamaguchi
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  4. Hiroyuki Ishii
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  5. Eiichiro Fukuda
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  6. Haruhisa Machida
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  7. Takashi Nakamura
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  8. Ken Ohnita
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  9. Saburo Shikuwa
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  10. Shigeru Kohno
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  11. Kazuhiko Nakao
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Corresponding author

Correspondence to Hajime Isomoto.

Additional information

H. Nishiyama, H. Isomoto, and N. Yamaguchi equally contributed to this work.

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Nishiyama, H., Isomoto, H., Yamaguchi, N. et al. Endoscopic submucosal dissection for laterally spreading tumours of the colorectum in 200 consecutive cases. Surg Endosc 24, 2881–2887 (2010). https://doi.org/10.1007/s00464-010-1071-5

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  • DOI: https://doi.org/10.1007/s00464-010-1071-5

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