title: Endoscopic submucosal dissection for colorectal epithelial neoplasms.
abstract: OBJECTIVE
  Endoscopic submucosal dissection permits removal of colorectal epithelial neoplasms en bloc, but long-term clinical outcomes remain unknown.
  
  
  METHODS
  Endoscopic submucosal dissection was performed in 282 patients having 296 colorectal tumors that fulfilled the inclusion criteria, which included lesions greater than 20 mm in size for which en bloc resection would be difficult with endoscopic mucosal resection, lesions with fibrotic scar due to previous endoscopic treatment or biopsies, locally residual lesions after endoscopic resection, or invasive carcinoma with slight submucosal penetration. En bloc or piecemeal resection, complete (en bloc with tumor-free lateral/basal margins) or incomplete resection, and complications were assessed, and factors related to each were analyzed using logistic regression. Patients with early colon cancer received endoscopic follow-up and metastatic surveys for a median of 34 months.
  
  
  RESULTS
  En bloc resection was achieved in 89.2% (264/296) and 234 lesions (79.1%) were deemed to have undergone complete resection. A right-side colonic location was the significant contributor to incomplete resection. Perforation was seen in 24 cases (8.1%) in association with tumor size and the presence of fibrosis. There was 1 case of locally recurrent tumor with incomplete resection, whereas neither recurrence nor residual disease was observed in the complete resection group. Neither cancer-related nor cancer-unrelated death was observed.
  
  
  CONCLUSIONS
  Precise assessment of curability with successful en bloc resection may reduce tumor recurrence after endoscopic submucosal dissection. The prognosis of early colorectal cancer in patients treated by endoscopic submucosal dissection is likely to be excellent, although further longer follow-up studies are warranted.
authors.affiliation: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Sakamoto, Nagasaki, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nishiyama
authors.forename: Hajime
authors.initials: H
authors.lastname: Isomoto
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Yamaguchi
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Fukuda
authors.forename: Kohki
authors.initials: K
authors.lastname: Ikeda
authors.forename: Ken
authors.initials: K
authors.lastname: Ohnita
authors.forename: Yohei
authors.initials: Y
authors.lastname: Mizuta
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakamura
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakao
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno
authors.forename: Saburo
authors.initials: S
authors.lastname: Shikuwa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome