title: Long-term outcomes after endoscopic submucosal dissection for superficial colorectal tumors.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) is an effective procedure for en bloc resection of superficial colorectal tumors regardless of tumor size or location. However, there are few reports on long-term outcomes for patients with superficial colorectal tumors after ESD. We therefore aimed to evaluate the long-term outcomes after ESD for superficial colorectal tumors.
  
  
  METHODS
  ESD was performed on 257 colorectal tumors in 255 consecutive patients at Hiroshima University Hospital between June 2003 and July 2010. We investigated the following variables: patient characteristics, the American Society of Anesthesiologists score, tumor location, tumor size, growth type, histology, en bloc resection rate, achievement of curative resection, procedure time, and adverse events. The 5-year overall survival (OS), 5-year disease-specific survival (DSS), local recurrence, and metachronous tumor occurrence were also analyzed.
  
  
  RESULTS
  We identified 224 tumors in 222 patients who were confirmed dead or had follow-up data for more than 5 years. After a median follow-up of 79 months, 5-year OS and DSS rates were 94.6% and 100%, respectively. The local recurrence rate (1.5%) was significantly higher in patients undergoing piecemeal resection (9.1%) compared with en bloc resection (0.6%), in cases of histologic incomplete resection compared with complete resection, and in cases of non-R0 resection compared with R0 resection. The rates of total number of tumors (≥6 mm) and carcinoma metachronous tumors after ESD without additional surgical resection were 18.9% (38/201) and 4.0% (8/201), respectively.
  
  
  CONCLUSIONS
  Long-term outcomes after ESD for superficial colorectal tumors are favorable. Patients should be surveyed for both local recurrence and metachronous tumors after ESD.
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Shigita
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: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Kyoku
authors.initials: K
authors.lastname: Sumimoto
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Daiki
authors.initials: D
authors.lastname: Hirano
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Tamaru
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Ninomiya
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Asayama
authors.affiliation: Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Nana
authors.initials: N
authors.lastname: Hayashi
authors.affiliation: Department of the Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Shimamoto
authors.affiliation: Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Arihiro
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000601:surgery; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D000069916:Endoscopic Mucosal Resection; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009378:Neoplasms, Multiple Primary / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden