Is endoscopic submucosal dissection safe in the management of early-stage colorectal cancers?

IF 2.7 3区医学 Q1 SURGERY American journal of surgery Pub Date : 2024-12-20 DOI:10.1016/j.amjsurg.2024.116159

Metincan Erkaya , Attila Ulkucu , Kamil Erozkan , Brogan Catalano , Daniela Allende , Scott Steele , Joshua Sommovilla , Emre Gorgun

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Abstract

Background

Endoscopic submucosal dissection (ESD) is increasingly being adopted for the treatment of early-stage colorectal cancer (CRC) lesions.

Methods

We retrospectively analyzed patients with early-stage CRC treated between 2015 and 2023, using ESD and colectomy databases, categorizing them into three groups: ESD only (n = 24), oncological colorectal resection (OCR) only (n = 90), and OCR after ESD (n = 59). We compared pathological and oncological outcomes among these groups.

Results

The OCR after ESD group demonstrated higher non-granular lesions, and deeper submucosal invasion compared to ESD only group. The primary OCR group showed higher 2-year overall survival compared to ESD-only group (98.9 % vs 85.6 %, p = 0.01), with no colorectal cancer-related mortality in any of the groups. Notably, 2-year disease-free survival rates were comparable across all groups (93.8 % ESD only, 88.0 % primary OCR only, and 97.8 % for OCR after ESD, p = 0.27).

Conclusion

The current study highlights feasibility the promising potential and oncologic safety of ESD in carefully selected patients with early malignant lesions.

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内镜下粘膜剥离治疗早期结直肠癌安全吗？

背景：内镜下粘膜下剥离术（ESD）越来越多地被用于早期结直肠癌（CRC）病变的治疗。方法：我们回顾性分析2015年至2023年期间接受ESD和结肠切除术治疗的早期结直肠癌患者，将其分为三组：仅ESD (n = 24)，仅肿瘤结肠切除术（n = 90）和ESD后的OCR （n = 59）。我们比较了这些组的病理和肿瘤结果。结果：与单纯ESD组相比，ESD组术后的OCR显示出更多的非颗粒状病变，粘膜下浸润更深。原发性OCR组的2年总生存率高于单纯esd组（98.9% vs 85.6%, p = 0.01），两组均无结直肠癌相关死亡率。值得注意的是，所有组的2年无病生存率具有可比性（仅ESD为93.8%，仅原发性OCR为88.0%，ESD后OCR为97.8%,p = 0.27）。结论：本研究强调了ESD在精心挑选的早期恶性病变患者中的可行性、前景和肿瘤安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.