Treatment strategy for recurrent or residual colorectal tumors after endoscopic resection.
BACKGROUND
Piecemeal resection of colorectal neoplasms is associated with a higher risk of recurrent or residual tumors, but nearly all such cases can be cured by additional endoscopic resection (ER). Although the adoption of endoscopic submucosal dissection (ESD) for colorectal neoplasm is continuing, the safety of this treatment for recurrent or residual tumors has not been fully assessed. We evaluated salvage therapy for the treatment of recurrent or residual tumors, and propose an endoscopic treatment strategy for these tumors.


METHODS
This retrospective study was conducted for 60 consecutive patients who had with locally recurrent or residual tumor after ER between January 2004 and October 2005. Endoscopic treatment strategy, treatment results, complications and clinical outcomes were recorded.


RESULTS
Among 69 lesions in 60 patients, 67 were treated endoscopically, whereas 2 required surgical treatment. Of these 67, 87% (58/67) were resected by endoscopic mucosal resection (EMR) and 13% (9/67) by ESD. En bloc resection rate was 39% (23/58) in the EMR group and 56% (5/9) in the ESD group. One limitation of this study is that it was a single-center retrospective analysis.


CONCLUSIONS
ESD is safe and effective for the treatment of recurrent or residual colorectal tumors. However, because of its technical difficulty, the en bloc resection rate is lower than that for the treatment of nonrecurrent lesions.
Sakamoto
Taku
T
Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. tasakamo@ncc.go.jp
Saito
Yutaka
Y
Matsuda
Takahisa
T
Fukunaga
Shusei
S
Nakajima
Takeshi
T
Fujii
Takahiro
T
D000230:Adenocarcinoma / Q000601:surgery*; D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008866:Microsurgery / Q000379:methods / Q000706:statistics & numerical data; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D018365:Neoplasm, Residual / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011351:Proctoscopy / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome