title: Endoscopic submucosal dissection for colorectal laterally spreading tumors.
abstract: OBJECTIVE
  Colorectal laterally spreading tumors are superficial tumors classified into two groups as granular (G-laterally spreading tumor) and non-granular (non-granular-laterally spreading tumor) types. In this study, we aimed to investigate the efficacy and feasibility of endoscopic submucosal dissection in the treatment of laterally spreading tumors.
  
  
  METHODS
  Forty-four laterally spreading tumors in 40 patients were treated with endoscopic submucosal dissection at a tertiary referral hospital. Patient data were collected retrospectively. In this study, we evaluated tumor size, macroscopic type, lesion location, histology, curative resection, and complications.
  
  
  RESULTS
  Of the 44 laterally spreading tumors excised by endoscopic submucosal dissection, 29 (65.9%) were G-laterally spreading tumor and 15 (34.1%) were non-granular-laterally spreading tumor. Most of the non-granular-laterally spreading tumors were localized in the right colon, while most G-laterally spreading tumors were localized in the left colon (p<0.001). There was also no difference between G-laterally spreading tumors (6/29) and non-granular-laterally spreading tumors (2/15) with regard to exhibiting malignant features (p=0.69). Although median size (40 mm vs. 27.5 mm) and procedure time (115 minutes vs. 60 minutes) for G-laterally spreading tumors were bigger and longer respectively, procedure time per cm2 was not different (8.9 minutes vs. 8.2 minutes) between the two groups. Curative resection rates for laterally spreading tumors were quite high (95.5%), while en bloc resection rates were low (77.3%). The rates of endoscopic submucosal dissection-related complications such as perforation, major and minor bleeding were low (4.5%, 2.3%, 6.8%, respectively).
  
  
  CONCLUSIONS
  Endoscopic submucosal dissection is an effective and safe therapeutic option with high curative rates for early-stage malignant and pre-malignant laterally spreading tumors not having an absolute indication for surgery, regardless of the lesion type and size.
authors.affiliation: Kocaeli University School of Medicine, Department of Gastroenterology, İzmit, Turkey.
authors.forename: Sadettin
authors.initials: S
authors.lastname: Hülagü
authors.forename: Ömer
authors.initials: Ö
authors.lastname: Şentürk
authors.forename: Uğur
authors.initials: U
authors.lastname: Korkmaz
authors.forename: Göktuğ
authors.initials: G
authors.lastname: Şirin
authors.forename: Ali Erkan
authors.initials: AE
authors.lastname: Duman
authors.forename: Gökhan
authors.initials: G
authors.lastname: Dindar
authors.forename: Altay
authors.initials: A
authors.lastname: Çelebi
authors.forename: Deniz Öğütmen
authors.initials: DÖ
authors.lastname: Koç
authors.forename: Neslihan
authors.initials: N
authors.lastname: Bozkurt
authors.forename: Hasan
authors.initials: H
authors.lastname: Yılmaz
authors.forename: Yeşim
authors.initials: Y
authors.lastname: Gürbüz
authors.forename: Deniz
authors.initials: D
authors.lastname: Duman
authors.forename: Orhan
authors.initials: O
authors.lastname: Tarçın
mesh_terms: D000236:Adenoma / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery*; D002432:Cecum / Q000473:pathology; D003106:Colon / Q000473:pathology; D003113:Colonoscopy / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D004210:Dissection / Q000009:adverse effects; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012007:Rectum / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden