Article Abstract

The role of endoscopic submucosal dissection for Tis/T1 rectal cancer

Authors: Hiroyuki Takamaru, Yutaka Saito, A. Aziz Aadam, Ghassan M. Hammoud, Masau Sekiguchi, Masayoshi Yamada, Seiichiro Abe, Taku Sakamoto, Takeshi Nakajima, Takahisa Matsuda


Background: Colorectal endoscopic submucosal dis-section (ESD) is widely used as a minimally invasive treatment for neoplasms in the colon and rectum. Rectal ESD is generally thought to be less complex than ESD in other segments of the colon, however difficult time-consuming lesions can be en-countered. Here we investigated the short-term outcomes of ESD for lesions in the upper rectum, lower rectum and anal canal.
Methods: From February 1998 to January 2017, 404 consecutive patients with 414 lesions of upper rectum (Ra), lower rectum (Rb) and anal canal (P), that underwent ESD at our hospital were analyzed. Age, gender, macroscopic feature, lesion size, location of the lesion, procedure time, histological diagnosis, depth of invasion and adverse effect such as intra-procedural perforation, delayed perforation and delayed bleeding, were evaluated as short-term outcomes. Univariate analysis between the lesions with depth of Tis/T1a and T1b was performed.
Results: The number of the lesions located at Ra, Rb and P was 104, 292, and 12, respectively. Mean procedure time was 109.2 minutes (SD ±77.5) and en bloc resection ratio was 95.2%. The overall ratio of curative resection was 80.9%. The ratio of intra-procedural perforation, delayed perforation and delayed bleeding was 1.0%, 0% and 3.9%, respectively. When comparing T1b lesions to Tis/T1a lesions, there is no difference in lesion size, procedure time, intra-procedural or delayed perforation ratio and delayed bleeding ratio between the two groups. Positive margins were encountered more frequently in the T1b group compared to the Tis/T1a group (21.0% vs. 5.5%).
Conclusions: ESD is feasible for Tis and T1a rectal cancers from the aspect of short-term outcomes and quality of life (QOL) for patients. Incomplete resection was still a problem for T1b cancers and collaboration between endoscopists who perform ESD and surgery has potential in the future.