There have been no definite indications for additional surgical resection after endoscopic submucosal dissection submucosal invasive colorectal cancer.
Dr Suh Jung Pil and colleagues evaluated the feasibility of endoscopic submucosal dissection for nonpedunculated submucosal invasive colorectal cancer.
The researchers determined the need for subsequent surgery after endoscopic submucosal dissection.
A total of 150 patients with nonpedunculated submucosal invasive colorectal cancer in resected specimens after endoscopic submucosal dissection were analyzed.
The team identified 75 patients that underwent subsequent surgery after endoscopic submucosal dissection.
Clinical outcomes of endoscopic submucosal dissection and histopathological risk factors for lymph node metastasis were evaluated.
The en-bloc resection and complete resection rates of endoscopic submucosal dissection were 98% and 95%, respectively.
|The complete resection rate of endoscopic submucosal dissection was 95%|
|European Journal of Gastroenterology & Hepatology|
None of the patients had delayed bleeding after endoscopic submucosal dissection.
The team found that perforations occurred in 7 patients, which were successfully treated by endoscopic clipping.
After subsequent surgery for 75 patients, lymph node metastases were found in 10 cases.
The incidence of lymph node metastasis was significantly higher in tumors featuring submucosal invasion of at least 1500 μm, lymphovascular invasion, and tumor budding.
The researchers showed that lymphovascular invasion and tumor budding were significantly associated with lymph node metastasis.
Among the 150 patients, no local recurrence or distant metastasis was detected, except one patient with risk factors and who refused subsequent surgery, during the overall median follow-up of 34 months.
Dr Jung Pil and colleagues conclude, "Endoscopic submucosal dissection is feasible and may be considered as an alternative treatment option for carefully selected cases of nonpedunculated submucosal invasive colorectal cancer, provided that the appropriate histopathological curative criteria are fulfilled in completely resectable endoscopic submucosal dissection specimens."