DOI: 10.3390/jcm12165356 ISSN:

Risk of Residual Neoplasia after a Local-Risk Resection of Colorectal Lesions by Endoscopic Submucosal Dissection: A Multinational Study

João Santos-Antunes, Mathieu Pioche, Felipe Ramos-Zabala, Paolo Cecinato, Francisco Gallego, Pedro Barreiro, André Mascarenhas, Sandro Sferrazza, Frieder Berr, Andrej Wagner, Arnaud Lemmers, Mariana Figueiredo Ferreira, Eduardo Albéniz, Hugo Uchima, Ricardo Küttner-Magalhães, Carlos Fernandes, Rui Morais, Sunil Gupta, Daniel Martinho-Dias, Isabel Faria-Ramos, Margarida Marques, Michael J. Bourke, Guilherme Macedo
  • General Medicine

Endoscopic submucosal dissection (ESD) in colorectal lesions is demanding, and a significant rate of non-curative procedures is expected. We aimed to assess the rate of residual lesion after a piecemeal ESD resection, or after an en bloc resection but with positive horizontal margins (local-risk resection—LocRR), for colorectal benign neoplasia. A retrospective multicenter analysis of consecutive colorectal ESDs was performed. Patients with LocRR ESDs for the treatment of benign colorectal lesions with at least one follow-up endoscopy were included. A cohort of en bloc resected lesions, with negative margins, was used as the control. A total of 2255 colorectal ESDs were reviewed; 352 of the ESDs were “non-curative”. Among them, 209 were LocRR: 133 high-grade dysplasia and 76 low-grade dysplasia. Ten cases were excluded due to missing data. A total of 146 consecutive curative resections were retrieved for comparison. Compared to the “curative group”, LocRRs were observed in lengthier procedures, with larger lesions, and in non-granular LSTs. Recurrence was higher in the LocRR group (16/199, 8% vs. 1/146, 0.7%; p = 0.002). However, statistical significance was lost when considering only en bloc resections with positive horizontal margins (p = 0.068). In conclusion, a higher rate of residual lesion was found after a piecemeal ESD resection, but not after an en bloc resection with positive horizontal margins.

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