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Published in: Surgical Endoscopy 4/2018

01-04-2018

Clinical outcomes of deep invasive submucosal colorectal cancer after ESD

Authors: Daisuke Watanabe, Takashi Toyonaga, Makoto Ooi, Tetsuya Yoshizaki, Yoshiko Ohara, Shinwa Tanaka, Fumiaki Kawara, Tsukasa Ishida, Yoshinori Morita, Eiji Umegaki, Takeru Matsuda, Yasuo Sumi, Mari Nishio, Hiroshi Yokozaki, Takeshi Azuma

Published in: Surgical Endoscopy | Issue 4/2018

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Abstract

Background and study aims

Endoscopic submucosal dissection (ESD) is a reliable method that can replace surgery under certain conditions. However, limited information is available on the clinical course of T1b colorectal cancer (CRC) after ESD. The aim of the study was to clarify the feasibility of ESD for T1b CRC.

Patients and methods

Three hundred and two patients with 312 T1 CRC were identified in this retrospective cohort study. All patients were treated with ESD, other endoscopic treatments, or surgery. In this study, we (I) investigated the en bloc resection rate of ESD and (II) compared the overall survival (OS) rate for patients who underwent ESD with additional surgery (Group A) and surgery without upfront endoscopic resection (Group B) for T1b CRC.

Results

No significant differences were observed in the en bloc resection rates between T1b and T1a CRC (100 vs. 98.7%), but the en bloc R0 resection rate was significantly lower in T1b CRC than in T1a CRC (64.7 vs. 97.4%). Regarding complications, perforations occurred in 2.9% of patients with T1b CRC, which was not significantly different from the rate of 5.3% in patients with T1a CRC. No significant differences were observed in the OS or recurrence-free survival (RFS) curves between Groups A and B (OS rates at 5 years: 92.3 vs. 88.9%, RFS rates at 5 years: 81.4 vs. 85.3%). Similarly, the 5-year disease-specific survival (DSS) rate of Group A was identical to that of Group B (both 100%).

Conclusions

ESD for T1b CRC before surgery is a possible strategy because of the low rate of complications and favorable long-term outcomes.
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Metadata
Title
Clinical outcomes of deep invasive submucosal colorectal cancer after ESD
Authors
Daisuke Watanabe
Takashi Toyonaga
Makoto Ooi
Tetsuya Yoshizaki
Yoshiko Ohara
Shinwa Tanaka
Fumiaki Kawara
Tsukasa Ishida
Yoshinori Morita
Eiji Umegaki
Takeru Matsuda
Yasuo Sumi
Mari Nishio
Hiroshi Yokozaki
Takeshi Azuma
Publication date
01-04-2018
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 4/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-017-5910-5

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