Aim: to identify risk factors for neoplasms recurrence removed by endoscopic mucosal resection (EMR).Patients and methods: the single-center retrospective observational study included 207 patients with 260 benign colon neoplasms. There were 95 (45.9%) males and 112 (54.1%) females. The median age of the patients was 67 (27-80) years. The results obtained were assessed using following criteria: morbidity rate, complication type, hospital stay, tumor site, number of neoplasms in colon, lateral growth, fragmentation rate, technical difficulties (mucosal fold convergence)during surgery, grade of dysplasia, recurrence rate.Results: intraoperative fragmentation of the neoplasms during mucosectomy occurred in 48/260 (18.5%) cases. Postoperative complications within the period of up to 30 days occurred in 13/207 (6.3%) patients. The most frequent 9 (4.2%) postoperative complication arising after mucosectomy was post-polypectomy syndrome. Another 4 (2.0%) patients produced bleeding after the surgery, which required repeated endoscopic procedure. No mortality occurred. The tumor size exceeding 25 mm (Exp (B) = 0.179; 95% CI = 0.05-0.7; p = 0.014), severe dysplasia (Exp (B) = 0.113; 95% CI = 0.03-0.4; p = 0.001) and fold convergence (Exp (B) = 0.2; 95% CI = 0.07-0.7; p = 0.015) are independent risk factors for disease recurrence.Conclusion: mucosectomy is indicated for colon adenomas if its size does not exceed 25 mm and can be removed en bloc.
AIM: transanal endomicrosurgery (TEM) is the standard for organ-preserving treatment of patients with large adenomas and early rectal cancer. The advantage of TEM in comparison with other transanal methods of treatment of rectal tumors is the low frequency of R1 resections and fragmentation, which procudes a low level of local recurrences. Endoscopic submucosal dissection (ESD) is a new technology for superficial rectum tumors. This systematic review and meta-analysis compared safety and efficacy of ESD vs TEM for large adenoma and early colorectal cancer.PATIENTS AND METHODS: a literature search and meta-analysis of the data was carried out in accordance with the English-language Medline database without restrictions on the publication date (end December 18, 2018) according to keywords: «endoscopic submucosal dissection», «esd», «endoscopic dissection», «tem», «tamis», «transanal endoscopic microsurgery», «transanal resection», «teo», «transanal endoscopic microsurgical excision». The systematic review includes all papers on the comparison of TEM and ESD for large adenomas and early rectal cancer. Statistical data processing was performed using Review Manager 5.3.RESULTS: four retrospective comparative studies were included in the analysis (215 patients). Groups were homogenous in the number of tumors (Odds ratio [OR]=1,19; 95% confidence interval [CI] 0.23-6.16) and size (p=0.55). The intraoperative morbidity included bleeding (p=0.54) and rectal perforation (p=0.32) was homogenous as well. The operation time in the ESD group was significantly longer by 32 minutes than TEM (OR=32.5;95% CI 17,7-47.4; p<0.0001). Postoperative stay was higher than in 1.6 times after TEM (OR=16.1; 95% CI 1.5-30.1; p=0.03). The antibiotics use after surgery was not significantly different in both groups (p=0.33). The en-bloc resections (p=0.66) and the rate of R1 resections (p=0.74) were not significantly different in both groups. The local recurrence rate was homogenous (p=0.95).CONCLUSIONS: the ESD and TEM procedures are safe and effective techniques for local excision of adenomas and early colorectal cancer, but a randomized study is needed to prove the results.
AIM: to assess results of endoscopic submucosal dissection (ESD) for colon neoplasms due to lesion site.PATIENTS AND METHODS: One-hundred thirteen patients (66 females, aged 65,7±11,0 years) with colon neoplasms which underwent ESD for one year (January 2017 – January 2018) were included in the study. All patients were divided in two groups depending on lesion site. The first group included patients with lesions in caecum, ascending colon and proximal third of tranverse colon, the second group – other colon parts and intraperitoneal part of the rectum. All patients underwent preoperative tests including colonoscopy, gastroscopy and transabdominal ultrasound. ESD included lesion marking, injection, circular incision and dissection. The results obtained were analyzed statistically using Graph Pad 7 for Mac. RESULTS: the 1st group included 61 (54.0%) patients and the 2nd – 52 (46.0%). Laterally spreading tumors (LST) were detected more often in the 1st group (56 patients of the 1st group vs 38 – in the 2nd, p=0.03). The lesion size in the 1st group was 31±13 (7-80) mm and 29±11 (8-76) in the 2nd one (p=0.3). Conversion from ESD to resection occurred in 9 (8.0%) patients, in 5 patients of the 1st group and in 4 – the 2nd one (p=1.0). The only reason for conversion was unfavorable lesion lifting (≤2 mm).Most of the lesions were removed en bloc, specimen fragmentation after ESD occurred in 10 (9.6%) patients: in 5 (9.0%) in the 1st group and in 5 (10.4%) in the 2nd (р=1.0). Intraoperative complications during ESD in the 1st group occurred in 2 (3.5%) cases and in 2 (4.1%) – in the 2nd (р=1.0). Postoperative complications were detected in 2 (1.9%) patients. Histopathology showed adenocarcinoma in 9 (8.0%) patients. Two (1.7%) patients produced local recurrence. CONCLUSION: ESD is a safe method removal of colon ademonas. The intra- and postoperative complications rate is 3.5% and 1.9% for the 1st and the 2nd group. Local recurrences occurred in 2,04%. Unfavorable lesion lifting (≤2 mm) in right colon is a risk factor for specimen fragmentation or conversion.
Aim: to identify the risk factors for conversion of endoscopic submucosal dissection to abdominal surgery.Patients and methods: the prospective cohort study included 405 patients: 166 (40.9%) males and 239 (59.1%) females. The median age was 66 (59; 72) years old; the patients underwent endoscopic submucosal dissection of colorectal epithelial neoplasms.Results: the median size of the removed neoplasms was 3.0 (2.4; 4) cm, tumor was removed en bloc in 324/363 (89.2%) cases; and R0 resection margins were detected in 218/324 (67.3%) cases. Significant risk factors for conversion were: the tumor size ≥ 3.2 cm (OR 2.9, 95% CI 1.2–7.1, p = 0.017), lifting ≤ 3 mm (OR 41, 95% CI 15–105, p = 0.000002) and the tumor vascular pattern IIIa according Sano’s capillary pattern classification (OR 4.0, 95% CI 1.3–11.9, p = 0.013).Conclusion: endoscopic submucosal dissection is a safe way to remove colorectal neoplasms. However, the presence of conversion risk factors can influence the outcome of endoscopic treatment.
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