Year 2020 / Volume 112 / Number 12
Original
Evaluation of recurrence and surgical complementation rates after endoscopic resection of large colorectal non-pedunculated lesions

898-902

DOI: 10.17235/reed.2020.6695/2019

Alanna Alexandre Silva de Azevedo, Maria Cecilia del Picchia Novaes Ribeiro, Fernando Lander Mota, Paulo Alberto Falco Pires Correa, Jarbas Faraco Maldonado Loureiro,

Abstract
Background and aim: the process that leads to the development of colorectal cancer takes many years and most tumors originate from polyps and non-polypoid lesions. Techniques of endoscopic resection are surgical treatment options, even in case of large lesions or with initial invasion. This study aimed to evaluate the recurrence and surgical complementation rates after endoscopic resection of large colorectal non-pedunculated lesions. Methods: a retrospective, longitudinal and descriptive trial was performed via an analysis of colonoscopies with the resection of non-pedunculated lesions larger than 3 cm, performed between 2014 and 2017. Results: sixty-two lesions were included from 61 patients and 32 (52.5 %) were female. The age ranged from 36 to 89 years, with a mean age of 60.5 years. Lesions had an average diameter of 40.08 mm, ranging from 30 to 80 mm. Regarding the location of the lesions, the most frequent colonic segments were the ascending and rectum, both accounting for 22.6 %. Considering the morphologic endoscopic classification, 67.7 % were granular laterally spreading tumors (LST), 38.8 % were homogeneous granular and 29 % were mixed granular. The most frequent histological types were tubulovillous adenoma (30.7 %) and intramucosal adenocarcinoma (29 %). The resection technique was piecemeal mucosectomy in 85.5 %. Five lesions were removed by en bloc mucosectomy, two (3.2 %) by endoscopic submucosal dissection (ESD) and two (3.2 %) by a hybrid technique. The recurrence rate was 25.8 %. Three patients needed complementary surgical treatment and the clinical success of endoscopic treatment was 95.1 %. Conclusion: recurrence rate after endoscopic resection of large colorectal lesions was 25.8 % and surgical complementation rate due to failure in the endoscopic treatment of recurrence was 4.8 %.
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References
1. Zhan T, Hahn F, Hielscher T , et al. Multiple behavioral factors are associated with occurrence of large, flat colorectal polyps. Int J Colorectal Dis. 2017; 32(4):575-582.
2. De Ceglie A, Hassan C, Mangiavillano B, et al. Endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions: A systematic review. Crit Rev OncolHematol. 2016; 104:138-55
3. Matsuda K, Masaki T, Abo Y, et al. Rapid growth of residual colonic tumor after incomplete mucosal resection. J Gastroenterol. 1999 Apr;34(2):260-3.
4. Fujita M, Tsuruta O, Ikeda H, et al.. Local recurrence of colorectal tumors after endoscopic mucosal resection. Int J Oncol. 1997 Sep;11(3):533-8.
5. Farrar WD, Sawhney MS, Nelson DB, et al. Colorectal cancers found after a complete colonoscopy. Clin Gastroenterol Hepatol. 2006 Oct;4(10):1259-64.
6. Loeve F, van Ballegooijen M, Boer R, et al. Colorectal cancer risk in adenoma patients: a nation-wide study. Int J Cancer 2004;111(1):147-51
7. Belderbos TD, Leenders M, Moons LM, et al. Local recurrenceafter endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy. 2014; 46(5):388-402.
8. Wang J, Zhang XH, Ge J, et al. Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal tumors: a meta-analysis. World J Gastroenterol. 2014;20(25):8282-8287.
9. Oka S, Tanaka S, Saito Y, et al. Colorectal Endoscopic Resection Standardization Implementation Working Group of the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan. Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan. Am J Gastroenterol. 2015;110(5):697-707.
10. Fujiya M, Tanaka K, Dokoshi T, et al. Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection. Gastrointest Endosc. 2015; 81(3):583-595.
11. Seidel J, Färber E, Baumbach R, et al. Complication and local recurrence rate after endoscopic resection of large high-risk colorectal adenomas of ≥3 cm in size. Int J Colorectal Dis. 2016;31:603–611.
12. Saito Y, Fukuzawa M, Matsuda T, et al. Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 2010 Feb;24(2):343-52.
13. Soune PA, Ménard C, Salah E, et al. Large endoscopic mucosal resection for colorectal tumors exceeding 4 cm. World J Gastroenterol. 2010;16(5):588-595
14. Moss A, Bourke MJ, Williams SJ, et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology. 2011; 140(7):1909-18.
15. Lee EJ, Lee JB, Lee SH, et al. Endoscopic treatment of large colorectal tumors: comparison of endoscopic mucosal resection, endoscopic mucosal resection-precutting, and endoscopic submucosal dissection. Surg Endosc. 2012; 26(8):2220-30
16. Knabe M , Pohl J, Gerges C , et al. Standardized Long-Term Follow-Up After Endoscopic Resection of Large, Nonpedunculated Colorectal Lesions: A Prospective Two-CenterStudy. Am J Gastroenterol. 2014; 109(2):183-9.
17. Lim SH, Levenick JM, Mathew A , et al. Endoscopic Management of Large (≥2 cm) Non-pedunculated Colorectal Polyps: Impact of Polyp Morphology on Outcomes. Dig Dis Sci. 2016;61:3572-3583
18. Tanaka S, Kashida H, Saito Y, et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopicmucosal resection. Dig. Endosc. 2015; 27(4):417-34..
19. Shinya H, Woff WI. Morphology, anatomic distribution and cancer potential of polyps: analysis of 7000 polyps endoscopically removed. Ann Surg. 1979;190(6):679-83.
20. Holmes I, Friedland S. Endoscopic Mucosal Resection versus Endoscopic Submucosal Dissection for Large Polyps: A Western Colonoscopist's View. Clin Endosc. 2016 Sep;49(5):454-456..
21. Saunders BP, Tsiamoulos ZP. Endoscopic mucosal resection and endoscopic submucosal dissection of large colonic polyps. Nature Reviews Gastroenterology & Hepatology. 2016 ;13(8):486-96.
22. Luigiano C, Consolo P, Scaffidi MG, et al. Endoscopic mucosal resection for large and giant sessile and flat colorectal polyps: a single-center experience with long-term follow-up. Endoscopy. 2009 Oct;41(10):829-35.
23. Zhan T, Hielscher T, Hahn F, et al. Risk Factors for Local Recurrence of Large, Flat Colorectal Polyps after Endoscopic Mucosal Resection. Digestion. 2016;93(4):311-7.
24. Briedigkeit A, Sultanie O, Sido B, et al. Endoscopic mucosal resection of colorectal adenomas > 20 mm: Risk factors for recurrence. World J Gastrointest Endosc. 2016; 8(5):276-281
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Azevedo A, Ribeiro M, Mota F, Correa P, Loureiro J. Evaluation of recurrence and surgical complementation rates after endoscopic resection of large colorectal non-pedunculated lesions. 6695/2019


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Publication history

Received: 21/10/2019

Accepted: 08/03/2020

Online First: 15/10/2020

Published: 09/12/2020

Article revision time: 123 days

Article Online First time: 360 days

Article editing time: 415 days


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