title: Endoscopic submucosal dissection vs laparoscopic colorectal resection for early colorectal epithelial neoplasia.
abstract: OBJECTIVE
  To compare the short term outcome of endoscopic submucosal dissection (ESD) with that of laparoscopic colorectal resection (LC) for the treatment of early colorectal epithelial neoplasms that are not amenable to conventional endoscopic removal.
  
  
  METHODS
  This was a retrospective cohort study. The clinical data of all consecutive patients who underwent ESD for endoscopically assessed benign lesions that were larger than 2 cm in diameter from 2009 to 2013 were collected. These patients were compared with a cohort of controls who underwent LC from 2005 to 2013. Lesions that were proven to be malignant by initial endoscopic biopsies were excluded. Mid and lower rectal lesions were not included because total mesorectal excision, which bears a more complicated postoperative course, is not indicated for lesions without histological proof of malignancy. Both ESD and LC were performed by the same surgical unit with a standardized technique. The patients were managed according to a standard protocol, and they were closely monitored for complications after the procedures. All hospital records were reviewed, and the following data were compared between the ESD and LC groups: patient demographics, size and location of the lesions, procedure time, short-term clinical outcomes and pathology results.
  
  
  RESULTS
  From 2005 to 2013, 65 patients who underwent ESD and 55 patients who underwent LC were included in this study. The two groups were similar in terms of sex (P = 0.41) and American Society of Anesthesiologist class (P = 0.58), although patients in the ESD group were slightly older (68.6 ± 9.4 vs 64.6 ± 9.9, P = 0.03). ESD could be accomplished with a shorter procedure time (113 ± 66 min vs 153 ± 43 min, P < 0.01) for lesions of comparable size (3.0 ± 1.2 cm vs 3.4 ± 1.4 cm, P = 0.22) and location (colon/rectum: 59/6 vs colon/rectum: 52/3, P = 0.43). ESD appeared to be associated with a lower short-term complication rate, but the difference did not reach statistical significance (10.8% vs 23.6%, P = 0.06). In the LC arm, a total of 22 complications occurred in 13 patients. A total of 7 complications occurred in the ESD arm, including 5 perforations and 2 episodes of bleeding. All perforations were observed during the procedure and were successfully managed by endoscopic clipping without emergency surgical intervention. Patients in the ESD arm had a faster recovery than patients in the LC arm, which included shorter time to resume normal diet (2 d vs 4 d, P = 0.01) and a shorter hospital stay (3 d vs 6 d, P < 0.01).
  
  
  CONCLUSIONS
  ESD showed better short-term clinical outcomes in this study. Further prospective randomized studies will be required to evaluate the efficacy and superiority of colorectal ESD over LC.
authors.affiliation: Sophie SF Hon, Simon SM Ng, Tiffany CL Wong, Philip WY Chiu, Tony WC Mak, WW Leung, Janet FY Lee, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Sophie Sf
authors.initials: SS
authors.lastname: Hon
authors.affiliation: Sophie SF Hon, Simon SM Ng, Tiffany CL Wong, Philip WY Chiu, Tony WC Mak, WW Leung, Janet FY Lee, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Simon Sm
authors.initials: SS
authors.lastname: Ng
authors.affiliation: Sophie SF Hon, Simon SM Ng, Tiffany CL Wong, Philip WY Chiu, Tony WC Mak, WW Leung, Janet FY Lee, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Tiffany Cl
authors.initials: TC
authors.lastname: Wong
authors.affiliation: Sophie SF Hon, Simon SM Ng, Tiffany CL Wong, Philip WY Chiu, Tony WC Mak, WW Leung, Janet FY Lee, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Philip Wy
authors.initials: PW
authors.lastname: Chiu
authors.affiliation: Sophie SF Hon, Simon SM Ng, Tiffany CL Wong, Philip WY Chiu, Tony WC Mak, WW Leung, Janet FY Lee, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Tony Wc
authors.initials: TW
authors.lastname: Mak
authors.affiliation: Sophie SF Hon, Simon SM Ng, Tiffany CL Wong, Philip WY Chiu, Tony WC Mak, WW Leung, Janet FY Lee, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: W W
authors.initials: WW
authors.lastname: Leung
authors.affiliation: Sophie SF Hon, Simon SM Ng, Tiffany CL Wong, Philip WY Chiu, Tony WC Mak, WW Leung, Janet FY Lee, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Janet Fy
authors.initials: JF
authors.lastname: Lee
keywords: Early colorectal neoplasia; Endoscopic submucosal dissection; Laparoscopic colectomy