title: Efficacy of endoscopic submucosal dissection for residual or recurrent superficial colorectal tumors after endoscopic mucosal resection.
abstract: OBJECTIVE
  Superficial colorectal tumors can be treated effectively by endoscopic submucosal dissection (ESD). Few data are available on using ESD for residual or recurrent tumors after the first endoscopic resection. This study aimed to evaluate the efficacy of ESD for these lesions.
  
  
  METHODS
  In all, 28 patients with residual or recurrent superficial colorectal tumors were referred to the Kobe University Hospital for ESD. The therapeutic outcomes and the possible factors predictive of procedure difficulties for ESD were analyzed.
  
  
  RESULTS
  In total, 27 (96.4%) patients were successfully treated using ESD. There was no related immediate complication. One patient had a delayed perforation which was then treated surgically. En bloc R0 resection was possible in all the patients and curative resection in 26 patients (92.9%). One invasive cancer was treated surgically. More than one previous endoscopic resection was the only significant predictive factor for the difficulty in performing ESD. None of the patients experienced recurrence during a follow-up of 22 months (range 3-41 months).
  
  
  CONCLUSIONS
  The use of ESD allowed a high rate of en bloc resection for residual or locally recurrent colorectal tumors. Furthermore, these lesions should be treated by ESD as a first-line treatment.
authors.affiliation: Department of Hepatogastroenterology and Digestive Endoscopy, Université Paris Descartes, Georges Pompidou European Hospital, Paris, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Rahmi
authors.forename: Shinwa
authors.initials: S
authors.lastname: Tanaka
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Ohara
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Ishida
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yoshizaki
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Morita
authors.forename: Takashi
authors.initials: T
authors.lastname: Toyonaga
authors.forename: Takeshi
authors.initials: T
authors.lastname: Azuma
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D018365:Neoplasm, Residual; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: colorectal neoplasms; complications; endoscopic submucosal dissection; residual tumor; treatment