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Am J Gastroenterol. 2015 May;110(5):697-707. doi: 10.1038/ajg.2015.96. Epub 2015 Apr 7.

Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan.

Author information

1
Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
2
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
3
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
4
Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan.
5
Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan.
6
Department of Endoscopy, Cancer Institute Ariake Hospital, Tokyo, Japan.
7
Digestive Disease Center, Asahikawa City Hospital, Hokkaido, Japan.
8
Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
9
Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Kanagawa, Japan.
10
Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
11
Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan.
12
Gastrointestinal Center, Sano Hospital, Hyogo, Japan.
13
Department of Gastroenterology, Akita Red Cross Hospital, Akita, Japan.
14
Department of Gastroenterology, JR West Osaka Railway Hospital, Osaka, Japan.
15
Department of Gastroenterology, Toranomon Hospital and Cancer Center, Keio University, Tokyo, Japan.
16
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
17
Department of Gastroenterology, Chofu Surgical Clinic, Tokyo, Japan.
18
Gastroenterology, Takahiro Fujii Clinic, Tokyo, Japan.
19
Department of Molecular-Targeting Cancer Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
20
Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.

Abstract

OBJECTIVES:

Conventional endoscopic resection (CER) is a widely accepted treatment for early colorectal neoplasia; however, large colorectal neoplasias remain problematic, as they necessitate piecemeal resection, increasing the risk of local recurrence. Endoscopic submucosal dissection (ESD) can improve the en bloc resection rate. This study aimed to evaluate local recurrence and its associated risk factors after endoscopic resection (ER) for colorectal neoplasias ≥20 mm.

METHODS:

A multicenter prospective study at 18 medium- and high-volume specialized institutions was conducted in Japan. Follow-up colonoscopy was performed after 12 months in cases of complete resection and after 3-6 months in cases of incomplete resection. Local recurrence was confirmed by endoscopic findings and/or pathological analysis.

RESULTS:

Follow-up colonoscopy was performed in 1,524 of 1,845 enrolled colorectal neoplasias (mean age, 65 years; 885 men; median tumor size, 32.8 mm). The local recurrence rates were 4.3% (65/1,524), 6.8% (55/808), and 1.4% (10/716) for the entire cohort, for CER, and for ESD, respectively. The relative risks of local recurrence were 0.21 (95% confidence interval, 0.11-0.39) with ESD compared with CER, 0.32 (95% confidence interval, 0.11-0.92) with en bloc ESD compared with en bloc CER, and 0.90 (95% confidence interval, 0.39-2.12) with piecemeal ESD compared with piecemeal CER. Significant factors associated with local recurrence were piecemeal resection, laterally spreading tumors of granular type, tumor size ≥40 mm, no pre-treatment magnification, and ≤10 years of experience in CER, and piecemeal resection only in ESD.

CONCLUSIONS:

En bloc ESD reduces the local recurrence rate for large colorectal neoplasias. Piecemeal resection is the most important risk factor for local recurrence regardless of the ER method used.

PMID:
25848926
DOI:
10.1038/ajg.2015.96
[Indexed for MEDLINE]

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