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Colorectal lateral spreading tumor subtypes: clinicopathology and outcome of endoscopic submucosal dissection

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

This study aims to investigate the clinicopathological features of specific subtypes of laterally spreading tumor (LST) and assessed the outcome of endoscopic submucosal dissection (ESD) based upon subdifferentiation status.

Methods

A total of 137 LSTs were present in 135 patients; 96 were granular and 41 exhibited a nongranular pattern. Granular LSTs, subdivided into homogeneous and nodular mixed, and nongranular LSTs, subdivided into flat-elevated and pseudodepressed, were retrospectively evaluated with respect to clinicopathological features and results of ESD (en bloc R0 curative resection, procedure time, complication, and recurrence rate) according to specific subtype.

Results

The distribution of high-grade intraepithelial neoplasia and submucosal carcinomas was more prominent among granular nodular mixed tumors than among granular homogeneous tumors (P = 0.007), whereas there was no significant difference between nongranular pseudodepressed tumors and flat-elevated tumors. The frequency of en bloc R0 curative resection did not differ significantly among specific subtypes. For nodular mixed and pseudodepressed lesions, the median tumor size was significantly larger (P < 0.001 for each) and mean procedure time was also longer (P < 0.05 for each) than for the other two subtypes. All complications, which included three perforations, five episodes of postoperative bleeding, and one recurrence, occurred in granular nodular mixed and nongranular pseudodepressed tumors.

Conclusion

The risk of cancer varies with the subtypes of LSTs. ESD is an effective treatment for LSTs, however ESD is more technically demanding and carries more complications in pseudodepressed and granular mixed subtypes.

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Acknowledgments

This study was supported by Project of National Natural Science Foundation of China (grant no. 1071046), Major Project of Shanghai Municipal Science and Technology Committee (09DZ1950102) and Special Project of Public Welfare Fund of Ministry of Health (200902002-3).

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Authors and Affiliations

  1. Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, China

    Mei-Dong Xu, Xiao-Yun Wang, Quan-Lin Li, Ping-Hong Zhou, Yi-Qun Zhang, Yun-Shi Zhong, Wei-Feng Chen, Li-Li Ma, Wen-Zheng Qin, Jian-Wei Hu & Li-Qing Yao

  2. People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China

    Xiao-Yun Wang

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  1. Mei-Dong Xu
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Correspondence to Li-Qing Yao.

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Mei-Dong Xu and Xiao-Yun Wang contributed equally to this work and should be considered co-first authors.

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Xu, MD., Wang, XY., Li, QL. et al. Colorectal lateral spreading tumor subtypes: clinicopathology and outcome of endoscopic submucosal dissection. Int J Colorectal Dis 28, 63–72 (2013). https://doi.org/10.1007/s00384-012-1543-2

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  • DOI: https://doi.org/10.1007/s00384-012-1543-2

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