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29 September 2018 : Clinical Research

Endoscopic Submucosal Dissection Decreases Additional Colorectal Resection for T1 Colorectal Cancer

Yuichi Tomiki1ABCDEF*, Masaya Kawai1B, Shingo Kawano1B, Shun Ishiyama1AB, Kiichi Sugimoto1ACD, Makoto Takahashi1B, Yutaka Kojima1C, Takashi Murakami2B, Hideaki Ritsuno2B, Tomoyoshi Shibuya2BE, Naoto Sakamoto2ABF, Kazuhiro Sakamoto1ACDEF

DOI: 10.12659/MSM.909380

Med Sci Monit 2018; 24: CLR6910-6917

Abstract

BACKGROUND: There are 3 methods of treating T1 colorectal cancer (T1 CRC), which include endoscopic resection, endoscopic resection followed by additional colorectal resection, and surgical resection. In this retrospective study, changes in the management of T1 CRC after introduction of endoscopic submucosal dissection (ESD) were investigated by comparison with the 10-year period before introduction of ESD.

MATERIAL AND METHODS: During a 20-year period from 1996 to 2015, 835 patients with T1 CRC were treated, including 331 patients before introduction of ESD (Group A) and 504 patients after introduction of ESD (Group B). Clinicopathological findings and treatment methods were compared between these 2 groups.

RESULTS: As the initial treatment, endoscopic treatment was performed in 185 patients (55.9%) in Group A and 288 (57.1%) in Group B. In Group B, ESD was performed in 161 patients (55.9%), accounting for more than half of the T1 CRC patients receiving endoscopic treatment. In Groups A and B, observation after endoscopic resection was selected for 54.2% and 67.3% of T1a patients, respectively (p=0.04). A similar trend was noted for T1b patients, and there was no significant difference of the treatment approach. Among all T1 CRC patients, the percentage undergoing observation after endoscopic resection was significantly higher in Group B than in Group A (34.3% vs. 26.9%, p=0.02), and the percentage of patients undergoing additional colorectal resection was significantly lower in Group B (22.8% vs. 29.0%, p=0.04).

CONCLUSIONS: After introduction of ESD, it was performed in more than half of all patients with T1 CRC undergoing endoscopic treatment. The percentage of patients undergoing observation following endoscopic resection of T1 CRC increased after introduction of ESD.

Keywords: Colorectal Neoplasms, Endoscopy, Gastrointestinal

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750