title: Endoscopic submucosal dissection for laterally spreading tumors in the rectum ≥40 mm.
abstract: BACKGROUND
  Endoscopic submucosal dissection (ESD) has been developed to allow en bloc resection of early neoplasia of the gastrointestinal tract, including colorectal tumors. The aim of the present study was to evaluate the safety and efficacy of ESD for laterally spreading tumors (LSTs) in the rectum with diameters of 40 mm or more.
  
  
  METHODS
  Between January 2010 and October 2014, 35 patients with a total of 36 LSTs of the rectum measuring ≥40 mm were included in this study. Clinical and pathological characteristics and clinical outcomes were examined and analyzed.
  
  
  RESULTS
  The mean operating time was 125.8 ± 61.4 min, and the mean size of the tumors was 59.4 ± 19.8 mm. The rate of en bloc resection and en bloc R0 resection were 91.7 % (33/36) and 88.9 % (32/36), respectively. Perforation occurred in three patients (8.6 %) and was managed conservatively. Postoperative bleeding occurred in one patient (2.9 %) and was treated by endoscopic hemostasis. Excluding five patients, who either underwent additional surgery (n = 1) or were lost to follow-up (n = 4), two patients in our cohort (6.7 %) presented with recurrence of a small adenoma. The remaining patients (n = 28) were free of recurrence during a mean follow-up period of 18.7 ± 4.2 months (range 12-43 months).
  
  
  CONCLUSIONS
  Our results indicated that ESD is an effective and safe therapeutic option with high curative rates for LSTs in the rectum ≥40 mm. To prove its long-term efficacy, a large multicenter prospective study is required.
authors.affiliation: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, No.1838, Guangzhou North Ave, Guangzhou, 510515, China.|Departmemt of Gastroenterology, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, Dongxiaokou Town, Changping District, Beijing, China.
authors.forename: X W
authors.initials: XW
authors.lastname: Tang
authors.affiliation: Departmemt of Gastroenterology, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, Dongxiaokou Town, Changping District, Beijing, China.
authors.forename: Y T
authors.initials: YT
authors.lastname: Ren
authors.affiliation: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, No.1838, Guangzhou North Ave, Guangzhou, 510515, China.|Departmemt of Gastroenterology, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, Dongxiaokou Town, Changping District, Beijing, China.
authors.forename: J Q
authors.initials: JQ
authors.lastname: Zhou
authors.affiliation: Departmemt of Gastroenterology, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, Dongxiaokou Town, Changping District, Beijing, China.
authors.forename: Z J
authors.initials: ZJ
authors.lastname: Wei
authors.affiliation: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, No.1838, Guangzhou North Ave, Guangzhou, 510515, China.
authors.forename: Z Y
authors.initials: ZY
authors.lastname: Chen
authors.affiliation: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, No.1838, Guangzhou North Ave, Guangzhou, 510515, China.|Departmemt of Gastroenterology, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, Dongxiaokou Town, Changping District, Beijing, China.
authors.forename: B
authors.initials: B
authors.lastname: Jiang
authors.affiliation: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, No.1838, Guangzhou North Ave, Guangzhou, 510515, China. drgwei@foxmail.com.
authors.forename: W
authors.initials: W
authors.lastname: Gong
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects; D005260:Female; D016558:Hemostasis, Endoscopic; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology*; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D018365:Neoplasm, Residual; D061646:Operative Time; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000628:therapy; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D047368:Tumor Burden
keywords: Endoscopic submucosal dissection; Laterally spreading tumors; Rectum