Intest Res.  2019 Jan;17(1):127-134. 10.5217/ir.2018.00075.

Clinicopathological feature and treatment outcome of patients with colorectal laterally spreading tumors treated by endoscopic submucosal dissection

Affiliations
  • 1Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea. yejoo@chonnam.ac.kr
  • 2Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea.
  • 3Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.
  • 4Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea.

Abstract

BACKGROUND/AIMS
Endoscopic submucosal dissection (ESD) is an advanced technique that can be used to treat precancerous and early colorectal neoplasms by facilitating en bloc resection regardless of tumor size. In our study, we investigated the clinicopathological feature and the treatment outcome of patients with colorectal laterally spreading tumors (LSTs) that were treated by ESD.
METHODS
The study enrolled all of 210 patients with colorectal LSTs who underwent ESD. Clinical outcomes were analyzed by retrospectively reviewing medical records.
RESULTS
A cancerous pit pattern (Vi/Vn) was more common in pseudo-depressed (PD) subtype than in flat elevated (FE) subtype. The incidence of adenocarcinoma in the PD subtype and nodular mixed (NM) subtypes was significantly higher than in the homogenous (HG) subtype and FE subtype. The en bloc and R0 resection rates were 89.0% and 85.7%, respectively. The bleeding and perforation rates were 5.2% and 1.9%, respectively. The mean procedure time was much longer in the PD subtype than in the FE subtype. The en bloc resection rate was significantly higher in the NM subtype than in the HG subtype. However, there were no statistically significant differences in mean procedure time, en bloc resection rate, R0 resection rate, bleeding rate, or perforation rate between LST-granular and LST-nongranular types.
CONCLUSIONS
These results indicate that ESD is acceptable for treating colorectal LSTs concerning en bloc resection, curative resection, and risk of complications. Careful consideration is required for complete resection of the PD subtype and NM subtype because of their higher malignant potential.

Keyword

Colonic neoplasms; Endoscopic submucosal dissection; Outcome

MeSH Terms

Adenocarcinoma
Colonic Neoplasms
Colorectal Neoplasms
Hemorrhage
Humans
Incidence
Medical Records
Retrospective Studies
Treatment Outcome*

Reference

1. Saunders BP, Tsiamoulos ZP. Endoscopic mucosal resection and endoscopic submucosal dissection of large colonic polyps. Nat Rev Gastroenterol Hepatol. 2016; 13:486–496.
Article
2. Ma MX, Bourke MJ. Complications of endoscopic polypectomy, endoscopic mucosal resection and endoscopic submucosal dissection in the colon. Best Pract Res Clin Gastroenterol. 2016; 30:749–767.
Article
3. De Ceglie A, Hassan C, Mangiavillano B, et al. Endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions: a systematic review. Crit Rev Oncol Hematol. 2016; 104:138–155.
Article
4. Xu JF, Yang L, Jin P, Sheng JQ. Endoscopic approach for superficial colorectal neoplasms. Gastrointest Tumors. 2016; 3:69–80.
Article
5. Kim TJ, Kim ER, Hong SN, Kim YH, Chang DK. Current practices in endoscopic submucosal dissection for colorectal neoplasms: a survey of indications among Korean endoscopists. Intest Res. 2017; 15:228–235.
Article
6. Lambert R, Tanaka S. Laterally spreading tumors in the colon and rectum. Eur J Gastroenterol Hepatol. 2012; 24:1123–1134.
Article
7. Facciorusso A, Antonino M, Di Maso M, Barone M, Muscatiello N. Non-polypoid colorectal neoplasms: classification, therapy and follow-up. World J Gastroenterol. 2015; 21:5149–5157.
Article
8. Kaku E, Oda Y, Murakami Y, et al. Proportion of flat- and depressed-type and laterally spreading tumor among advanced colorectal neoplasia. Clin Gastroenterol Hepatol. 2011; 9:503–508.
Article
9. Kudo SE, Takemura O, Ohtsuka K. Flat and depressed types of early colorectal cancers: from East to West. Gastrointest Endosc Clin N Am. 2008; 18:581–593.
Article
10. Oka S, Tanaka S, Kanao H, Oba S, Chayama K. Therapeutic strategy for colorectal laterally spreading tumor. Dig Endosc. 2009; 21 Suppl 1:S43–S46.
Article
11. Kobayashi N, Saito Y, Uraoka T, Matsuda T, Suzuki H, Fujii T. Treatment strategy for laterally spreading tumors in Japan: before and after the introduction of endoscopic submucosal dissection. J Gastroenterol Hepatol. 2009; 24:1387–1392.
Article
12. Uraoka T, Saito Y, Matsuda T, et al. Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut. 2006; 55:1592–1597.
Article
13. Huang Y, Liu S, Gong W, Zhi F, Pan D, Jiang B. Clinicopathologic features and endoscopic mucosal resection of laterally spreading tumors: experience from China. Int J Colorectal Dis. 2009; 24:1441–1450.
Article
14. Cong ZJ, Hu LH, Ji JT, et al. A long-term follow-up study on the prognosis of endoscopic submucosal dissection for colorectal laterally spreading tumors. Gastrointest Endosc. 2016; 83:800–807.
Article
15. Xu MD, Wang XY, Li QL, et al. Colorectal lateral spreading tumor subtypes: clinicopathology and outcome of endoscopic submucosal dissection. Int J Colorectal Dis. 2013; 28:63–72.
Article
16. Terasaki M, Tanaka S, Oka S, et al. Clinical outcomes of endoscopic submucosal dissection and endoscopic mucosal resection for laterally spreading tumors larger than 20 mm. J Gastroenterol Hepatol. 2012; 27:734–740.
Article
17. Nishiyama H, Isomoto H, Yamaguchi N, et al. Endoscopic submucosal dissection for laterally spreading tumours of the colorectum in 200 consecutive cases. Surg Endosc. 2010; 24:2881–2887.
Article
18. Toyonaga T, Man-i M, Fujita T, et al. Retrospective study of technical aspects and complications of endoscopic submucosal dissection for laterally spreading tumors of the colorectum. Endoscopy. 2010; 42:714–722.
Article
19. Kim BC, Chang HJ, Han KS, et al. Clinicopathological differences of laterally spreading tumors of the colorectum according to gross appearance. Endoscopy. 2011; 43:100–107.
Article
20. Rotondano G, Bianco MA, Buffoli F, Gizzi G, Tessari F, Cipolletta L. The Cooperative Italian FLIN Study Group: prevalence and clinico-pathological features of colorectal laterally spreading tumors. Endoscopy. 2011; 43:856–861.
Article
21. Kim KO, Jang BI, Jang WJ, Lee SH. Laterally spreading tumors of the colorectum: clinicopathologic features and malignant potential by macroscopic morphology. Int J Colorectal Dis. 2013; 28:1661–1666.
Article
22. Miyamoto H, Ikematsu H, Fujii S, et al. Clinicopathological differences of laterally spreading tumors arising in the colon and rectum. Int J Colorectal Dis. 2014; 29:1069–1075.
Article
23. Zhao X, Zhan Q, Xiang L, et al. Clinicopathological characteristics of laterally spreading colorectal tumor. PLoS One. 2014; 9:e94552.
Article
24. Sugimoto T, Ohta M, Ikenoue T, et al. Macroscopic morphologic subtypes of laterally spreading colorectal tumors showing distinct molecular alterations. Int J Cancer. 2010; 127:1562–1569.
Article
25. Kudo S, Rubio CA, Teixeira CR, Kashida H, Kogure E. Pit pattern in colorectal neoplasia: endoscopic magnifying view. Endoscopy. 2001; 33:367–373.
Article
26. Boman FT, Carneiro F, Hruban RH, Theise ND. World Health Organization classification of tumours of the digestive system. 4th ed. Lyon: IARC;2010. p. 134–146.
Full Text Links
  • IR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr