ESD Linked to Improved Outcomes for Large Colorectal Epithelial Neoplasms

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Researchers examined the long-term outcomes of endoscopic submucosal dissection in patients with colorectal epithelial neoplasms.

Endoscopic submucosal dissection (ESD) is associated with beneficial long-term outcomes for patients with large colorectal epithelial neoplasms, according to a study in Gastroenterology.

The multicenter, prospective cohort trial with a 5-year observation period assessed patients’ prognosis and local recurrence rate when ESD procedures were performed to treat colorectal epithelial neoplasms greater than or equal to 20 mm in diameter.

Consecutive patients scheduled for colorectal ESD were enrolled from February 2013 to January 2015. Planned surveillance examinations, including colonoscopy and computed tomography scan, were conducted to check for local recurrences and/or metastatic occurrences during the observation period after initial endoscopic treatment.

Primary outcomes included overall survival (OS), disease-specific survival (DSS), and intestinal preservation rates. DSS and OS rates were compared in curative resection (CR) and non-CR lesions.

A total of 1965 lesions in 1883 patients (mean age, 67.4±10.8 years; men, 58.4%) were treated with ESD. The researchers included 1814 epithelial lesions greater than or equal to 20 mm in 1740 patients to analyze the long-term outcomes after colorectal ESD.

DSS rates at 1, 3, and 5 years after initial ESD were 100%, 99.9%, and 99.6%, respectively. The corresponding OS rates were 99.6%, 97.4%, and 93.6%, respectively. Kaplan-Meier analysis showed that the DSS rate was significantly increased in patients with CR lesions vs participants with non-CR lesions (P <.001), with comparable findings observed in the OS rate (P =.009). The 5-year intestinal preservation rate was 88.6%, and in patients with CR lesions it was 98.1%.

The endoscopic surveillance analysis included 1503 lesions from 1437 patients who had endoscopic examination at least once during the 5-year follow-up. The colonoscopy rate at follow-up was 82.9%. During median follow-up at 46.0 (IQR, 25.4-60.0) months, a median number of 2.0 (IQR, 1.0-2.3) surveillance colonoscopies were performed per patient. Of this group, local recurrence occurred in 8 (0.5%) cases, and all were successfully resected endoscopically.

Piecemeal resection (hazard ratio [HR], 8.19; 95% CI, 1.47-45.7; P =.02) and margin-positive resection (HR, 8.06; 95% CI, 1.76-37.0; P =.007) were significant independent predictors of local recurrence after ESD for the treatment of colorectal epithelial lesions greater than or equal to 20 mm among the variables included in the Cox proportional hazard regression analysis.

During the follow-up, 15 (1.0%) cases of metachronous invasive cancer were identified during surveillance colonoscopy. The median duration from the initial ESD to identification of these lesions was 26.8 (IQR, 23.4-43.6) months, and a median of 2.0 (IQR, 1.0-2.0) colonoscopies was needed for detection. The proportion of patients with metachronous invasive cancers was 0.2% at 1 year, 0.9% at 3 years, and 3.0% at 5 years, respectively, after initial ESD.

Study limitations include a lack of randomization with comparative groups and the fact that not all patients received follow-up colonoscopy. In addition, the researchers did not obtain biopsy specimens from all ESD scars.

“ESD can be a standard treatment strategy for the colorectal epithelial neoplasms suggesting intramucosal or submucosal superficial cancers,” the study authors wrote.

Reference

Ohata K, Kobayashi N, Sakai E, et al. Long-term outcomes after endoscopic submucosal dissection for large colorectal epithelial neoplasms: a prospective, multicenter, cohort trial from Japan. Gastroenterology. Published online July 7, 2022. doi:10.1053/j.gastro.2022.07.002