title: Endoscopic submucosal dissection for early rectal neoplasia: experience from a European center.
abstract: Background and study aimsEndoscopic resection is a curative treatment option for large nonpedunculated colorectal polyps (LNPCPs). Endoscopic submucosal dissection (ESD) allows en bloc resection but ESD experience is still limited outside Asia. The aim of our study was to evaluate the role of ESD in the treatment of early rectal neoplasia in a European center.Patients and methods330 patients referred for endoscopic resection of rectal LNPCPs were included prospectively.ResultsESD was performed for 302 LNPCPs (median diameter 40 mm). Submucosal invasive cancer (SMIC) was present in 17.2 % (n = 52). SMIC was associated with Paris type (54.5 % among type 0-Is lesions, 100 % of 0-Is-IIc type, 0 % of 0-IIa, 14.9 % of 0-IIa-Is, and 59.3 % of 0-IIa-IIc type;P< 0.001) and with surface pattern (71.4 % among nongranular plus mixed surface lesions, 17.9 % of lesions with granular surface and nodule ≥ 10 mm). For SMICs, resection rates were en bloc 81.4 %, R0 65.1 %, and curative 30.2 %. Curative resection rate improved from 13.6 % to 47.6 % over the study period (P= 0.036). The reason for 83.3 % (25/30) of noncurative resections was submucosal invasion exceeding 1000 µm. For benign lesions (n = 250, 82.8 %), the R0 resection increased from 55.2 % to 84.8 % over the study period (P< 0.001). Recurrence rate was 4.8 %, bleeding rate 5.2 %, and perforation rate 0.8 % (all complications managed conservatively). Median follow-up was 35 months.ConclusionsThe majority of rectal LNPCPs are benign lesions. ESD offers high R0 resection and low recurrence rates but EMR may be appropriate. In lesions with a risk for SMIC, ESD should be offered to achieve R0 resection. Despite high rates of R0 resection the curative resection rate of ESD for rectal SMIC is < 50 %. Pretherapeutic lesion selection needs improvement.
authors.affiliation: Department of Gastroenterology, Klinikum Augsburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Probst
authors.affiliation: Department of Gastroenterology, Klinikum Augsburg, Germany.
authors.forename: Alanna
authors.initials: A
authors.lastname: Ebigbo
authors.affiliation: Institute of Pathology, Klinikum Augsburg, Germany.
authors.forename: Bruno
authors.initials: B
authors.lastname: Märkl
authors.affiliation: Institute of Pathology, Klinikum Augsburg, Germany.
authors.forename: Tina
authors.initials: T
authors.lastname: Schaller
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Klinikum Augsburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Anthuber
authors.affiliation: Department of Gastroenterology, Klinikum Augsburg, Germany.
authors.forename: Carola
authors.initials: C
authors.lastname: Fleischmann
authors.affiliation: Department of Gastroenterology, Klinikum Augsburg, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Messmann
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*; D000069916:Endoscopic Mucosal Resection; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome