title: Endoscopic submucosal dissection for anorectal tumor with hemorrhoids close to the dentate line: a multicenter study of Hiroshima GI Endoscopy Study Group.
abstract: The lower rectum close to the dentate line has distinct characteristics, making endoscopic submucosal dissection (ESD) of tumors challenging. We assessed clinical outcomes of ESD for such patients with hemorrhoids.
  
  
  
  Sixty-four patients (mean age, 68 years) underwent ESD for anorectal tumors close to the dentate line. We divided patients into those with (Group A, 45 patients) and without hemorrhoids (Group B, 19 patients). We examined en bloc and histological en bloc resection rates, procedure time, complication rates, and postoperative prognosis after ESD.
  
  
  
  The mean tumor size was 43 mm. Histologic diagnoses were adenoma (42 %, 27/64), carcinoma in situ (44 %, 28/64), and T1 carcinoma (14 %, 9/64). There was no significant difference in en bloc resection (93 %, 42/45 vs. 95 %, 18/19) or postoperative bleeding rates (16 %, 7/45 vs. 11 %, 2/19) between Groups A and B, respectively. The mean procedural durations were 120 and 124 min, respectively, in Groups A and B. No perforations occurred. There was no significant difference in postoperative anal pain rate between Groups A (18 %, 8/45) and B (16 %, 3/19), and it resolved within a few days in all cases. There was one case of stricture in Group B. Two patients with T1 carcinoma underwent additional surgery, one underwent chemotherapy, and five had no additional treatment. No recurrence occurred during the follow-up period of 38 months.
  
  
  
  ESD is safe and effective for anorectal tumors close to the dentate line in patients with hemorrhoids.
authors.affiliation: Department of Endoscopy, Hiroshima University Hospital, 1-2-3, Kasumi Minami-ku, Hiroshima, Japan.|Hiroshima GI Endoscopy Study Group, Hiroshima, Japan.
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Tamaru
authors.affiliation: Department of Endoscopy, Hiroshima University Hospital, 1-2-3, Kasumi Minami-ku, Hiroshima, Japan. oka4683@hiroshima-u.ac.jp.|Hiroshima GI Endoscopy Study Group, Hiroshima, Japan. oka4683@hiroshima-u.ac.jp.
authors.forename: Shiro
authors.initials: S
authors.lastname: Oka
authors.affiliation: Department of Endoscopy, Hiroshima University Hospital, 1-2-3, Kasumi Minami-ku, Hiroshima, Japan.|Hiroshima GI Endoscopy Study Group, Hiroshima, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Hiroshima GI Endoscopy Study Group, Hiroshima, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Hiraga
authors.affiliation: Hiroshima GI Endoscopy Study Group, Hiroshima, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kunihiro
authors.affiliation: Hiroshima GI Endoscopy Study Group, Hiroshima, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Nagata
authors.affiliation: Hiroshima GI Endoscopy Study Group, Hiroshima, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Furudoi
authors.affiliation: Hiroshima GI Endoscopy Study Group, Hiroshima, Japan.|Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Ninomiya
authors.affiliation: Hiroshima GI Endoscopy Study Group, Hiroshima, Japan.|Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Asayama
authors.affiliation: Hiroshima GI Endoscopy Study Group, Hiroshima, Japan.|Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Shigita
authors.affiliation: Hiroshima GI Endoscopy Study Group, Hiroshima, Japan.|Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Soki
authors.initials: S
authors.lastname: Nishiyama
authors.affiliation: Hiroshima GI Endoscopy Study Group, Hiroshima, Japan.|Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Nana
authors.initials: N
authors.lastname: Hayashi
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000069916:Endoscopic Mucosal Resection / Q000379:methods; D005260:Female; D006484:Hemorrhoids / Q000150:complications* / Q000473:pathology; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D012004:Rectal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Dentate line; Endoscopic submucosal dissection; Hemorrhoid; Rectal tumor