Endoscopic treatment outcomes of laterally spreading tumors with a skirt (with video).
OBJECTIVE
A "skirt" is a slightly elevated flat lesion with wide pits occasionally observed at the margin of laterally spreading tumors (LSTs). However, the endoscopic treatment outcomes of LSTs with skirts have not been clarified. The aim of this study was to evaluate the endoscopic treatment outcomes of LSTs with skirts.


METHODS
Between February 2006 and March 2014, 996 LSTs were retrospectively examined to assess the clinicopathologic characteristics, procedure time, en bloc resection rate, R0 resection rate, adverse events, and local recurrence rate of endoscopic submucosal dissection (ESD) and of endoscopic resection.


RESULTS
Endoscopic treatment was performed in 35 cases of LSTs with skirts (ratio of ESD to endoscopic piecemeal mucosal resection [EPMR], 32:3) and 961 cases of LSTs without skirts (ratio of ESD to EMR to EPMR to polypectomy, 381:275:114:191). LSTs with a skirt were associated with a significantly higher recurrence rate (P < .01). In both ESD and EPMR, LSTs with a skirt were associated with a higher recurrence rate when compared with LSTs without a skirt (odds ratio, 12.7; P = .032, and odds ratio, 12.3; P = .061, respectively). Multivariate analysis demonstrated that the presence of the skirt and piecemeal resection were significant predictors of local recurrence.


CONCLUSIONS
LSTs with skirts had a significantly higher local recurrence rate after endoscopic treatment compared with LSTs without skirts, especially after EPMR. Therefore, ESD should be recommended as an endoscopic treatment for LSTs with skirts to minimize local recurrence.
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan; Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Nagano, Japan.
Shozo
S
Osera
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan.
Hiroaki
H
Ikematsu
Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
Satoshi
S
Fujii
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan.
Keisuke
K
Hori
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan.
Yasuhiro
Y
Oono
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan.
Tomonori
T
Yano
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan.
Kazuhiro
K
Kaneko
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D016017:Odds Ratio; D012189:Retrospective Studies; D016896:Treatment Outcome