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Surgical Endoscopy
Published in: Surgical Endoscopy 10/2016

01-10-2016

Endoscopic submucosal dissection for anorectal tumor with hemorrhoids close to the dentate line: a multicenter study of Hiroshima GI Endoscopy Study Group

Authors: Yuzuru Tamaru, Shiro Oka, Shinji Tanaka, Yuko Hiraga, Masaki Kunihiro, Shinji Nagata, Akira Furudoi, Yuki Ninomiya, Naoki Asayama, Kenjiro Shigita, Soki Nishiyama, Nana Hayashi, Kazuaki Chayama

Published in: Surgical Endoscopy | Issue 10/2016

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Abstract

Background

The lower rectum close to the dentate line has distinct characteristics, making endoscopic submucosal dissection (ESD) of tumors challenging. We assessed clinical outcomes of ESD for such patients with hemorrhoids.

Methods

Sixty-four patients (mean age, 68 years) underwent ESD for anorectal tumors close to the dentate line. We divided patients into those with (Group A, 45 patients) and without hemorrhoids (Group B, 19 patients). We examined en bloc and histological en bloc resection rates, procedure time, complication rates, and postoperative prognosis after ESD.

Results

The mean tumor size was 43 mm. Histologic diagnoses were adenoma (42 %, 27/64), carcinoma in situ (44 %, 28/64), and T1 carcinoma (14 %, 9/64). There was no significant difference in en bloc resection (93 %, 42/45 vs. 95 %, 18/19) or postoperative bleeding rates (16 %, 7/45 vs. 11 %, 2/19) between Groups A and B, respectively. The mean procedural durations were 120 and 124 min, respectively, in Groups A and B. No perforations occurred. There was no significant difference in postoperative anal pain rate between Groups A (18 %, 8/45) and B (16 %, 3/19), and it resolved within a few days in all cases. There was one case of stricture in Group B. Two patients with T1 carcinoma underwent additional surgery, one underwent chemotherapy, and five had no additional treatment. No recurrence occurred during the follow-up period of 38 months.

Conclusions

ESD is safe and effective for anorectal tumors close to the dentate line in patients with hemorrhoids.
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Metadata
Title
Endoscopic submucosal dissection for anorectal tumor with hemorrhoids close to the dentate line: a multicenter study of Hiroshima GI Endoscopy Study Group
Authors
Yuzuru Tamaru
Shiro Oka
Shinji Tanaka
Yuko Hiraga
Masaki Kunihiro
Shinji Nagata
Akira Furudoi
Yuki Ninomiya
Naoki Asayama
Kenjiro Shigita
Soki Nishiyama
Nana Hayashi
Kazuaki Chayama
Publication date
01-10-2016
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 10/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-4761-9

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