Treatment strategy for local recurrences after endoscopic resection of a colorectal neoplasm.
Cold polypectomy
Colorectal neoplasm
Endoscopic mucosal resection
Endoscopic submucosal dissection
Local recurrence
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
received:
20
06
2018
accepted:
20
07
2018
pubmed:
26
7
2018
medline:
10
4
2020
entrez:
26
7
2018
Statut:
ppublish
Résumé
Endoscopic salvage treatment for recurrent or residual neoplasms is sometimes technically challenging, and information in choice of treatment methods is lacking. This study aimed to clarify the appropriate treatment strategy for local recurrence after endoscopic resection (ER). Seventy-four patients with 74 lesions who received endoscopic treatment for local recurrence after ER for colorectal epithelial neoplasms between January 2010 and December 2016 were enrolled. Patients with hyperplastic polyp, sessile-serrated adenoma/polyp, and submucosal invasive cancer in their initial ER were excluded. Treatment methods, treatment outcomes, and recurrence rate were evaluated for each recurrence based on the preoperative endoscopic diagnosis (adenomatous or cancerous). Forty-nine of the 74 patients diagnosed with adenomatous recurrence were treated using cold polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD) in 15, 26, and 8 patients, respectively. Cold polypectomy was applied only to diminutive lesions. EMR and ESD en bloc resection rates were 53.8 and 100%, respectively (p = 0.030). Two patients (7.7%) in the EMR group developed local recurrence, but an additional ER achieved complete resection. Meanwhile, the remaining 25 patients diagnosed with cancerous recurrence were treated via EMR and ESD for 7 and 18 patients, respectively. EMR and ESD en bloc resection rates were 28.6 and 83.3%, respectively (p = 0.017). Three patients (42.9%) in the EMR group developed recurrence. Selecting appropriate treatment methods for adenomatous recurrence could be decided based on estimated pathology and lesion size. ESD was effective for cancerous recurrence to achieve complete disease control.
Sections du résumé
BACKGROUND AND AIM
Endoscopic salvage treatment for recurrent or residual neoplasms is sometimes technically challenging, and information in choice of treatment methods is lacking. This study aimed to clarify the appropriate treatment strategy for local recurrence after endoscopic resection (ER).
METHODS
Seventy-four patients with 74 lesions who received endoscopic treatment for local recurrence after ER for colorectal epithelial neoplasms between January 2010 and December 2016 were enrolled. Patients with hyperplastic polyp, sessile-serrated adenoma/polyp, and submucosal invasive cancer in their initial ER were excluded. Treatment methods, treatment outcomes, and recurrence rate were evaluated for each recurrence based on the preoperative endoscopic diagnosis (adenomatous or cancerous).
RESULTS
Forty-nine of the 74 patients diagnosed with adenomatous recurrence were treated using cold polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD) in 15, 26, and 8 patients, respectively. Cold polypectomy was applied only to diminutive lesions. EMR and ESD en bloc resection rates were 53.8 and 100%, respectively (p = 0.030). Two patients (7.7%) in the EMR group developed local recurrence, but an additional ER achieved complete resection. Meanwhile, the remaining 25 patients diagnosed with cancerous recurrence were treated via EMR and ESD for 7 and 18 patients, respectively. EMR and ESD en bloc resection rates were 28.6 and 83.3%, respectively (p = 0.017). Three patients (42.9%) in the EMR group developed recurrence.
CONCLUSIONS
Selecting appropriate treatment methods for adenomatous recurrence could be decided based on estimated pathology and lesion size. ESD was effective for cancerous recurrence to achieve complete disease control.
Identifiants
pubmed: 30043171
doi: 10.1007/s00464-018-6373-z
pii: 10.1007/s00464-018-6373-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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