title: Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan.
abstract: OBJECTIVE
  Conventional endoscopic resection (CER) is a widely accepted treatment for early colorectal neoplasia; however, large colorectal neoplasias remain problematic, as they necessitate piecemeal resection, increasing the risk of local recurrence. Endoscopic submucosal dissection (ESD) can improve the en bloc resection rate. This study aimed to evaluate local recurrence and its associated risk factors after endoscopic resection (ER) for colorectal neoplasias ≥20 mm.
  
  
  METHODS
  A multicenter prospective study at 18 medium- and high-volume specialized institutions was conducted in Japan. Follow-up colonoscopy was performed after 12 months in cases of complete resection and after 3-6 months in cases of incomplete resection. Local recurrence was confirmed by endoscopic findings and/or pathological analysis.
  
  
  RESULTS
  Follow-up colonoscopy was performed in 1,524 of 1,845 enrolled colorectal neoplasias (mean age, 65 years; 885 men; median tumor size, 32.8 mm). The local recurrence rates were 4.3% (65/1,524), 6.8% (55/808), and 1.4% (10/716) for the entire cohort, for CER, and for ESD, respectively. The relative risks of local recurrence were 0.21 (95% confidence interval, 0.11-0.39) with ESD compared with CER, 0.32 (95% confidence interval, 0.11-0.92) with en bloc ESD compared with en bloc CER, and 0.90 (95% confidence interval, 0.39-2.12) with piecemeal ESD compared with piecemeal CER. Significant factors associated with local recurrence were piecemeal resection, laterally spreading tumors of granular type, tumor size ≥40 mm, no pre-treatment magnification, and ≤10 years of experience in CER, and piecemeal resection only in ESD.
  
  
  CONCLUSIONS
  En bloc ESD reduces the local recurrence rate for large colorectal neoplasias. Piecemeal resection is the most important risk factor for local recurrence regardless of the ER method used.
authors.affiliation: Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Oka
authors.affiliation: Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saito
authors.affiliation: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iishi
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan.
authors.forename: Shin-ei
authors.initials: SE
authors.lastname: Kudo
authors.affiliation: Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ikematsu
authors.affiliation: Department of Endoscopy, Cancer Institute Ariake Hospital, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Igarashi
authors.affiliation: Digestive Disease Center, Asahikawa City Hospital, Hokkaido, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Saitoh
authors.affiliation: Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Inoue
authors.affiliation: Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Kanagawa, Japan.
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Hisabe
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Tsuruta
authors.affiliation: Gastrointestinal Center, Sano Hospital, Hyogo, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sano
authors.affiliation: Department of Gastroenterology, Akita Red Cross Hospital, Akita, Japan.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Yamano
authors.affiliation: Department of Gastroenterology, JR West Osaka Railway Hospital, Osaka, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Shimizu
authors.affiliation: Department of Gastroenterology, Toranomon Hospital and Cancer Center, Keio University, Tokyo, Japan.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Yahagi
authors.affiliation: Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Gastroenterology, Chofu Surgical Clinic, Tokyo, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Nakamura
authors.affiliation: Gastroenterology, Takahiro Fujii Clinic, Tokyo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fujii
authors.affiliation: Department of Molecular-Targeting Cancer Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishikawa
authors.affiliation: Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugihara
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000473:pathology* / Q000601:surgery*; D002983:Clinical Competence; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D004210:Dissection / Q000379:methods*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D007564:Japan; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011446:Prospective Studies; D012307:Risk Factors; D047368:Tumor Burden
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