Achieving R0 resection in the colorectum using endoscopic submucosal dissection

Hurlstone, David P.; Atkinson, R. J. A.; Sanders, David S.; Thomson, Mike; Cross, Simon S.; Brown, S. R.

doi:10.1002/bjs.5720

Cited by 132 publications

(78 citation statements)

References 26 publications

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“…The ESD technique is still not a treatment at ease, and further refinements of the technique is required to popularize ESD as a safe and reliable, less invasive treatment for patients with GI neoplasms. [33] 2002 EMRSH 70 4 0 Ishigooka [34] 2004 s-ERHSE 34 0 12 Oda [35] 2005 ESD-IT knife 1 033 6 4 Kakushima [32] 2006 ESD-Flex knife 383 3.4 3.9 Imagawa [36] 2006 ESD-Flex knife 159 0 6.1 Oyama [37] 2006 ESD-Hook knife 111 -1 Onozato [38] 2006 ESD-Flex knife 171 7.6 3.5 Hirasaki [39] 2007 ESD-IT knife 112 4 1 Esophagus Oyama [8] 2005 ESD-Hook knife 102 -0 Fujishiro [11] 2006 ESD-Flex knife 58 0 6.9 Colorectum Fujishiro [31] 2007 ESD-Flex knife 200 1 6 Saito [40] 2007 ESD-several knives 200 2 5 Tanaka [41] 2007 ESD-several knives 70 1.4 10 Tamegai [42] 2007 ESD-Hook knife 74 -1.4 Hurlstone [50] 2007 ESD-Flex knife 42 12 2.4 Onozato [43] 2007 ESD-Flex knife 35 0 2.9…”

Section: Future Perspectivesmentioning

confidence: 99%

Endoscopic submucosal dissection for gastrointestinal neoplasms

Kakushima¹,

Fujishiro²

2008

WJG

160

131

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Endoscopic submucosal dissection (ESD) is an advanced technique of therapeutic endoscopy for superficial gastrointestinal neoplasms. Three steps characterize it: injecting fluid into the submucosa to elevate the lesion, cutting the surrounding mucosa of the lesion, and dissecting the submucosa beneath the lesion. The ESD technique has rapidly permeated in Japan for treatment of early gastric cancer, due to its excellent results of enbloc resection compared to endoscopic mucosal resection (EMR). Although there is still room for improvement to lessen its technical difficulty, ESD has recently been applied to esophageal and colorectal neoplasms. Favorable short-term results have been reported, but the application of ESD should be well considered by three aspects: (1) the possibility of nodal metastases of the lesion, (2) technical difficulty such as location, ulceration and operator's skill, and (3) organ characteristics.

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Section: Future Perspectivesmentioning

confidence: 99%

Endoscopic submucosal dissection for gastrointestinal neoplasms

Kakushima¹,

Fujishiro²

2008

WJG

160

131

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“…Endoscopic resection (ER) has become a major curative treatment for early colorectal carcinoma without lymph node metastasis (Kudo 1993;Ueno et al 2004;Hurlstone et al 2007). Therefore, the number of cases of ER for early colorectal carcinoma has increased.…”

mentioning

confidence: 99%

Prognostic and Diagnostic Significance of Tumor Budding Associated with β-Catenin Expression in Submucosal Invasive Colorectal Carcinoma

Umemura

Takagi

Shimada

et al. 2013

Tohoku J. Exp. Med.

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Endoscopic resection has become a major curative treatment for early colorectal carcinoma without lymph node metastasis. However, lymph node metastasis, a poor prognostic factor in colorectal carcinoma, occurs in about 10% of the patients with submucosal invasive colorectal carcinoma. Therefore, it is important to identify a high-risk factor for lymph node metastasis in submucosal invasive colorectal carcinoma. This study was designed to identify the relationship between tumor budding with β-catenin expression and lymph node metastasis in submucosal invasive colorectal carcinoma. We investigated the immunohistochemistry of tumor budding in the 142 patients who underwent surgical resection for submucosal invasive colorectal carcinomas between 1984 and 1999 and the expression pattern of β-catenin in budding tumor cells. Accordingly, all the patients were followed up for at least 10 years or until death. Among the 142 patients, lymph node metastasis was detected in 14 patients (9.9%). Univariate analysis showed that tumor budding with ≥ 5 tumor cells or cell clusters with expression of β-catenin in the nucleus was significantly associated with lymph node metastasis (P = 0.005). In contrast, tumor budding detected by hematoxylin and eosin staining was not associated with lymph node metastasis. Multivariate logistic regression analysis showed that tumor budding with ≥ 5 tumor cells or cell clusters with expression of β-catenin in the nucleus was a significant risk factor for lymph node metastasis (odds ratio, 7.124; 95% confidence interval, 1.407-36.062). Thus, tumor budding associated with β-catenin expression is a risk factor for lymph node metastasis in submucosal invasive colorectal carcinoma.

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“…However, for large sessile lesions, endoscopic mucosal resection (EMR) techniques may be inadequate to achieve a documented en bloc resection, and piecemeal resection has been reported to have a recurrence rate as high as 11.2 % [7]. On the other hand, endoscopic submucosal dissection (ESD) still remains a technical challenge without clear advantages compared to EMR in terms of achieving R0 resections [8][9][10][11]. Therefore, transanal surgery is mostly indicated.…”

mentioning

confidence: 99%

Recurrence after transanal endoscopic microsurgery for large rectal adenomas

et al. 2012

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Background Transanal endoscopic microsurgery (TEM) has revolutionized the technique and outcome of transanal surgery, becoming the standard of treatment for large sessile rectal adenomas. Nevertheless, only a few studies have evaluated the risk factors for local recurrence in order to recommend a "tailored" approach. The aim of this study was to identify predictor variables for recurrence after TEM to treat rectal adenoma. Methods This study is a retrospective analysis of a prospective database of patients treated for large sessile rectal adenomas by TEM at our institution, with a minimum follow-up of 12 months. Age, gender, tumor diameter, distance from the anal verge, degree of dysplasia, histology, and margin involvement were investigated. Results Between January 1993 and July 2010, 293 patients with a rectal adenoma ≥3 cm underwent TEM. Postoperative morbidity rate was 7.2 % (21/293) and there was no 30-day mortality. Over a median follow-up period of 110 (range = 12-216) months, 13 patients (5.6 %) were diagnosed with local recurrence. The median time to recurrence was 10 (range = 4-33) months, with 76.9 % of recurrences detected within 12 months after TEM. At univariate analysis, tumor diameter (p = 0.007), and positive margins (p < 0.001) were shown to be significant risk factors, while multivariate analysis indicated the presence of positive margins as the only independent predictor of recurrence (p = 0.003). Conclusions TEM provides excellent oncological outcomes in the treatment of large sessile benign rectal lesions, assuring a minimal risk of resection margin infiltration at pathology examination, which represents the only risk factor for recurrence. Keywords Transanal endoscopic microsurgery Rectal adenoma Recurrence Risk factors Rectal cancer is a common disease in Western countries, with increased incidence in the elderly, males, and obese people [1,2]. Dysplasia precedes the occurrence of invasive rectal cancer [3,4]. Endoscopic detection and removal of rectal adenomas prevents the development of rectal cancer, significantly contributing to the "cure" of the disease [5,6]. Complete resection of the precancerous lesion is mandatory to prevent recurrence. However, for large sessile lesions, endoscopic mucosal resection (EMR) techniques may be inadequate to achieve a documented en bloc resection, and piecemeal resection has been reported to have a recurrence rate as high as 11.2 % [7]. On the other hand, endoscopic submucosal dissection (ESD) still remains a technical challenge without clear advantages compared to EMR in terms of achieving R0 resections [8][9][10][11]. Therefore, transanal surgery is mostly indicated.

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Achieving R0 resection in the colorectum using endoscopic submucosal dissection

Cited by 132 publications

References 26 publications

Endoscopic submucosal dissection for gastrointestinal neoplasms

Endoscopic submucosal dissection for gastrointestinal neoplasms

Prognostic and Diagnostic Significance of Tumor Budding Associated with β-Catenin Expression in Submucosal Invasive Colorectal Carcinoma

Recurrence after transanal endoscopic microsurgery for large rectal adenomas

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