Laparoscopic-Facilitated Endoscopic Submucosal Dissection, Mucosal Resection, and Partial Circumferential (“Wedge”) Colon Wall Resection for Benign Colorectal Neoplasms That Come to Surgery

Jang, Joon Ho; Kirchoff, Daniel D.; Holzman, Kevin; Park, Koji; Grieco, Michael J.; Cekic, Vesna; Naffouje, Samer A.; Kluft, Jon; Whelan, Richard L.

doi:10.1177/1553350612456098

Cited by 9 publications

(14 citation statements)

References 10 publications

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“…In summary, 3275 studies were identified by the Embase and Pubmed searches and one by searching the reference list of selected papers. After removing non‐pertinent papers, 55 abstracts were selected and 11 published papers were included in the systematic review 11 , 15–24 . The reasons for exclusion are given in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…After removing non-pertinent papers, 55 abstracts were selected and 11 published papers were included in the systematic review. 11,[15][16][17][18][19][20][21][22][23][24] The reasons for exclusion are given in Figure 1.…”

Section: Study Selectionmentioning

confidence: 99%

“…The combined laparo‐endoscopic local resections of large colorectal polyps may represent an advantage for these instances. Endoscopy might provide additional safety for the surgeon by precise localisation of the lesion and endoluminal observation of resection and reconstruction and might reduce the invasiveness of the surgical approach 11 . However, most of these studies are retrospective and single‐centre studies that included only a relatively small number of cases.…”

Section: Introductionmentioning

confidence: 99%

“…Endoscopy might provide additional safety for the surgeon by precise localisation of the lesion and endoluminal observation of resection and reconstruction and might reduce the invasiveness of the surgical approach. 11 However, most of these studies are retrospective and single-centre studies that included only a relatively small number of cases. When considering the relatively low frequency of recurrences or complications, such small sample sizes prevent reliable estimates of the efficacy and safety of the technique.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of laparo‐endoscopic resections of colorectal neoplasia: A systematic review

et al. 2015

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Objective: The purpose of this review is to assess the efficacy and safety of laparo-endoscopic local resections for colorectal lesions not suitable for endoscopic resection. Summary background data: The combined laparo-endoscopic approach has been proposed for large colorectal lesions unsuitable for endoscopic resection, in order to reduce morbidity of common laparoscopic resection. However, data on the efficacy and safety of laparo-endoscopic local resections are still controversial. Methods: An Embase search of papers published during the period 1985-2014 was performed. Published studies that evaluated laparo-endoscopic resections for colorectal lesions were assessed using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) recommendations by two authors. Forest plots on primary (per-lesion rate of further surgery, including surgery for complications and surgery for oncologic radical treatment) and secondary outcomes were produced based on fixed and random effects models. Heterogeneity was assessed using the I 2 statistic. Risk for within-study bias was ascertained with QUADAS (Quality Assessment of Diagnostic Accuracy Studies) system. Results: A total of 11 studies provided data on 707 lesions treated with a combined laparo-endoscopic approach. A variety of techniques were reported. The overall per-lesion rate of further surgery was 9.5%, while per-lesion rate of further surgery for oncologic treatment was 7.9%, per-lesion rate of further surgery for complications treatment was 3.5%, incidence of adenocarcinoma was 10.5%, incidence of overall complications was 7.9%, incidence of conversion to open surgery 4.3% and incidence of recurrence was 5.4%. Conclusions: Despite laparo-endoscopic approach ensures limited invasiveness, it is affected by a consistent rate of complications and oncologic inadequacy that often requires further surgical treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of laparo‐endoscopic resections of colorectal neoplasia: A systematic review

et al. 2015

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“…The endoscopic removal is with strict laparoscopic visualization of the serosal aspect of the polypectomy area, which allows any subtle change to be recognized and repaired if needed. For lesions inaccessible for endoscopic removal, a small colectomy for resection of the polyp or an endoscopy-assisted wedge resection could be performed [ 22 – 24 ]. It has to be determined whether these more limited procedures are associated with lower morbidity and mortality rates, shortened length of hospital stay and the advantage of preservation of the colon.…”

Section: Discussionmentioning

confidence: 99%

The impact of the national bowel screening program in the Netherlands on detection and treatment of endoscopically unresectable benign polyps

et al. 2017

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BackgroundIn January 2014, a national bowel cancer screening program started in the Netherlands. The program is being implemented in phases until 2019. Due to this program, an increase in patients referred for a colorectal resection for benign, but endoscopically unresectable polyps, is expected. So far, most resections are performed according to oncological principles despite no pre-operative histological diagnosis of malignancy. The aim of this study was to analyze the increase in referred patients during the first year of the screening program and to compare pathological results and clinical outcome of resections of patients undergoing resection for benign polyps before and after implementation of screening.MethodsPatients referred for colorectal resection without biopsy-proven cancer between January 2009 and January December 2014 were identified from a prospectively maintained database. Patients with endoscopically macroscopic features of carcinoma were excluded.ResultsSeventy-six patients were included. Forty-seven patients (61.8%) were operated on in the 5 years prior to implementation of the screening program, and 29 patients (38.2%) were operated during the first year of implementation of the screening program. The overall malignancy rate before the introduction of the program was 14.1 and 6.6% after it had started (p = .469). All resections were performed laparoscopically; the conversion rate was 3.9% (n = 3). The overall mortality rate was 2.7% (n = 2), major complications (Clavien–Dindo > 3b) occurred in 11.8% (n = 9) of patients. The anastomotic leakage rate was 3.9% (n = 3).ConclusionsThe number of patients referred for benign polyps tripled after introduction of the screening program. With an overall major morbidity and mortality rate of 11.8%, it seems valid to discuss whether an endoscopic excision with advanced techniques with or without laparoscopic assistance would be preferable in this patient group, accepting a 6.6% reoperation rate for additional oncological resection with lymph node sampling in patients in whom a malignancy is found on histological analysis of the complete polyp.

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Management of Large Sessile Cecal Polyps

Howe¹,

Whelan²

2017

Difficult Decisions in Colorectal Surgery

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Laparoscopic-Facilitated Endoscopic Submucosal Dissection, Mucosal Resection, and Partial Circumferential (“Wedge”) Colon Wall Resection for Benign Colorectal Neoplasms That Come to Surgery

Abstract: ESD/EMR and WR appear to be safe but techniques are evolving. Larger studies are needed.

Cited by 9 publications

References 10 publications

Efficacy and safety of laparo‐endoscopic resections of colorectal neoplasia: A systematic review

Efficacy and safety of laparo‐endoscopic resections of colorectal neoplasia: A systematic review

The impact of the national bowel screening program in the Netherlands on detection and treatment of endoscopically unresectable benign polyps

Management of Large Sessile Cecal Polyps

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