title: Endoscopic submucosal dissection for colorectal lateral spreading tumors larger than 10 cm: is it feasible?
abstract: BACKGROUND
  Colorectal endoscopic submucosal dissection (ESD) was applied to lesions, such as giant colorectal lateral spreading tumors (LSTs) > 10 cm, by an expert ESD endoscopist despite several limitations, such as a relatively high perforation rate and high technical difficulty.
  
  
  OBJECTIVE
  To investigate the feasibility and safety of ESD for giant colorectal LSTs ≥ 10 cm.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Tertiary-care center.
  
  
  METHODS
  A total of 163 patients underwent colorectal ESD between 2009 and 2014 by a single expert ESD endoscopist at Gangnam Severance Hospital, Seoul, Korea. Among them, 9 patients had giant colorectal LSTs ≥ 10 cm.
  
  
  METHODS
  Review of records.
  
  
  METHODS
  Clinicopathologic factors and oncologic outcome associated with ESD between giant colorectal LSTs and others.
  
  
  RESULTS
  Colorectal LSTs ≥ 10 cm were classified as giant colorectal LSTs. Nine giant colorectal LST lesions were localized to the following regions: descending colon (n = 1), sigmoid colon (n = 1), and rectum (n = 7). The average maximal diameter of giant colorectal LSTs was 120.8 mm, and the procedure time was 270.0 minutes. Two lesions were of the whole nodular type, and 7 were focal nodular lesions. The en bloc and curative resection rates for ESD for giant colorectal LSTs were 88.9% and 100%, respectively. The adverse event rate was 44.4%. No strictures, local recurrences, or distant metastases occurred over a mean follow-up period of 27.1 months.
  
  
  CONCLUSIONS
  Retrospective, single-center study.
  
  
  CONCLUSIONS
  ESD of giant colorectal LSTs appears to be a feasible and curative treatment, even though it is associated with a higher adverse event rate, higher degree of technical difficulty, and longer procedure time.
authors.affiliation: Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Da Hyun
authors.initials: DH
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Youn
authors.affiliation: Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jie-Hyun
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hyojin
authors.initials: H
authors.lastname: Park
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies