Efficacy and safety of additional surgery after non-curative endoscopic submucosal dissection for early colorectal cancer

Chen, Tao; Zhang, Yiqun; Chen, Weifeng; Hou, Yayi; Yao, Ling; Zhong, Yun‐Shi; Xu, Mei‐Dong; Zhou, Ping‐Hong

doi:10.1186/s12876-017-0701-y

Cited by 19 publications

(15 citation statements)

References 14 publications

(17 reference statements)

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“…At present, only endoscopists with extensive experience in performing en bloc endoscopic resection should perform ESD for lesions with deeper submucosal invasion. The present study did not show significant differences between the two groups in the complication rate (5 vs. 4%, respectively, p = 0.733), which was in line with the findings of previous studies [26].…”

Section: Discussionsupporting

confidence: 93%

Does Additional Laparoscopic-Assisted Surgery after Endoscopic Submucosal Dissection Affect Short Outcomes in Patients with Stage T1 Colorectal Cancer? A Propensity Score-Based Analysis

Cheng¹,

Zhao²,

Huang³

et al. 2021

Dig Surg

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Background: Additional surgery is necessary in cases with non-curative endoscopic submucosal dissection. It is still unknown whether preceding endoscopic submucosal dissection (ESD) for T1 colorectal carcinoma affects the short outcomes of patients who underwent additional surgery or not as compared with surgery alone without ESD. Methods: Patients (101 pairs) with T1 colorectal cancer who underwent additional laparoscopic-assisted surgery after endoscopic submucosal dissection (additional surgery group, n = 101) or laparoscopic-assisted surgery alone (surgery alone group, n = 101) were matched (1:1). Short-term morbidity, operation outcomes, and lymph node metastasis of the resected specimen were compared. Results: There were no significant differences between the additional laparoscopic-assisted surgery and laparoscopic-assisted surgery alone groups in lymph node metastasis (9.9 vs. 5.9%, respectively, p = 0.297), operative time (147.76 ± 52.00 min vs. 156.50 ± 54.28 min, p = 0.205), first flatus time (3.56 ± 1.10 days vs. 3.63 ± 1.05 days, p = 0.282), first stool time (4.30 ± 1.04 days vs. 4.39 ± 1.22 days, p = 0.293), time to intake (5.00 ± 1.18 days vs. 5.25 ± 1.39 days, p = 0.079), blood loss (44.75 ± 45.40 mL vs. 60.40 ± 78.98 mL, p = 0.603), harvest lymph nodes (18.74 ± 7.22 vs. 20.32 ± 9.69, p = 0.438), postoperative surgical complications (p = 0.733), and postoperative length of hospital stay (8.68 ± 4.00 days vs. 8.39 ± 1.94 days, p = 0.401). Conclusion: ESD did not increase the difficulty of additional laparoscopic-assisted surgery, hospital stay, or the incidence of postoperative complications. Additional laparoscopic-assisted surgery is safe and recommended for patients with T1 cancer at high risk of lymph node metastasis and residual cancer after non-curative ESD.

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Section: Discussionsupporting

confidence: 93%

Does Additional Laparoscopic-Assisted Surgery after Endoscopic Submucosal Dissection Affect Short Outcomes in Patients with Stage T1 Colorectal Cancer? A Propensity Score-Based Analysis

Cheng¹,

Zhao²,

Huang³

et al. 2021

Dig Surg

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“…Currently, DSI is the most prevalent criterion to refrain from endoscopic resection or refer for additional surgery. 13,14 However, studies have shown conflicting results on its predictive value, and accumulating evidence suggests DSI is only a weak predictor for LNM in the absence of other risk factors, with rates of approximately 1.6%-2.2%. [15][16][17] This limited risk may outweigh surgery-related mortality and recurrence despite oncologic surgery.…”

mentioning

confidence: 99%

Deep Submucosal Invasion Is Not an Independent Risk Factor for Lymph Node Metastasis in T1 Colorectal Cancer: A Meta-Analysis

et al. 2022

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“…ESD is a minimally-invasive treatment that has been widely applied in recent years for the treatment of early-stage CRC; however, both patients and doctors have concerns about the possibility of disease recurrence due to non-curative ESD ( 13 ). Several studies have reported histopathologic and other risk factors for residual cancer and LN metastasis after non-curative endoscopic resection of early-stage CRC ( 7 , 9 , 10 ). Despite the high clinical and practical significance, until now there have been few reports on outcomes from ESD in early-stage CRC ( 14 - 16 ).…”

Section: Discussionmentioning

confidence: 99%

“…Currently, research on non-curative ESD for early CRC mostly focuses on pathological features predicting risk of residual cancer or LN metastasis (7)(8)(9)(10). Very few studies have been found to concentrate on the treatment patterns and outcomes.…”

Section: Introductionmentioning

confidence: 99%

Patient outcomes after non-curative endoscopic submucosal dissection for early colorectal cancer: a single-center, retrospective cohort study

Li¹,

Huang²,

Cheng³

et al. 2021

Transl Cancer Res TCR

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Background: The treatment patterns and outcomes for patients after non-curative endoscopic submucosal dissection (ESD) remain controversial, particularly among those requiring preservation of the anal sphincter or advanced age. This retrospective study aimed to investigate the treatment patterns and outcomes in patients after non-curative ESD for early colorectal cancer (CRC). Methods: This was a retrospective review in Chinese patients who received non-curative ESD for early CRC, and who were treated in the Cancer Hospital at the Chinese Academy of Medical Sciences from 2010 to 2019. Demographic parameters, clinicopathologic features, treatment patterns, and clinical outcomes were analyzed.Results: Of the 180 patients who received non-curative ESD, 85 received additional surgery; the remaining 95 patients were kept under surveillance only. Patients in the surveillance-only group tended to be older than those in the additional surgery group. Furthermore, tumors in the surveillance-only group were located in the rectum significantly more often, were better differentiated with a shallower depth of invasion and less perineuronal invasion than in the additional surgery group; there were fewer high-risk factors for residual cancer or lymph node (LN) metastasis in the surveillance-only group compared with the additional surgery group. There was no significant difference in 5-year overall survival (OS) (92.6% versus 92.7%, P=0.355), 5-year disease-free survival (DFS) (94.7% versus 91.9%, P=0.340), 5-year cancer-specific survival (CSS) (93.8% versus 92.7%, P=0.791), or total recurrence rates (4.7% versus 9.5%, P=0.217) between the additional surgery and surveillance-only groups, respectively.Conclusions: ESD results in favorable outcomes for patients with early CRC. Surveillance in patients who receive non-curative ESD may be an alternative option for those with advanced age and fewer high-risk factors for residual cancer or LN metastasis.

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Efficacy and safety of additional surgery after non-curative endoscopic submucosal dissection for early colorectal cancer

Cited by 19 publications

References 14 publications

Does Additional Laparoscopic-Assisted Surgery after Endoscopic Submucosal Dissection Affect Short Outcomes in Patients with Stage T1 Colorectal Cancer? A Propensity Score-Based Analysis

Does Additional Laparoscopic-Assisted Surgery after Endoscopic Submucosal Dissection Affect Short Outcomes in Patients with Stage T1 Colorectal Cancer? A Propensity Score-Based Analysis

Deep Submucosal Invasion Is Not an Independent Risk Factor for Lymph Node Metastasis in T1 Colorectal Cancer: A Meta-Analysis

Patient outcomes after non-curative endoscopic submucosal dissection for early colorectal cancer: a single-center, retrospective cohort study

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