Post written by Kazuki Boda, MD, from the Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
The focus of our study was to investigate the clinical outcomes of colorectal endoscopic submucosal dissection (ESD) at a regional level.
Because the morbidity associated with colon carcinomas is rising in Japan, the number of ESDs for colorectal tumors will continue to increase. Colorectal ESD is technically more difficult and requires more experience than gastric ESD. Although advanced high-volume centers have reported good outcomes of colorectal ESD, a limited number of highly skilled experts in specialized institutions performed these procedures. Few reports are available that describe the outcomes of colorectal ESD by less-experienced endoscopists, and the current status regarding colorectal ESD at a regional level has not been disclosed.
We recruited 1233 consecutive patients with 1259 colorectal tumors resected by ESD at 12 institutions, which included non-specialized hospitals in the Hiroshima area. The en bloc, histologic complete, and R0 resection rates were 92.6%, 87.4%, and 83.7%, respectively. The delayed bleeding, intraoperative perforation, and delayed perforation rates were 3.7%, 3.4%, and 0.4%, respectively. The long-term outcomes analysis included 1091 patients. Local recurrences occurred in 1.7% and metachronous tumors developed in 11%. The 3-year and 5-year overall survival rates were 95.1% and 92.3%, respectively.
Figure 1. Flowchart of the enrolled patients and the tumors. ESD, Endoscopic submucosal dissection.
We categorized the 12 participating hospitals into high-volume centers or low-volume centers, based on the number of ESDs during the study period. The number of colonic tumors, severe fibrosis, and the en bloc resection rates were significantly higher in the high-volume centers than those in the low-volume centers. The average tumor size in the high-volume centers was significantly larger than that in the low-volume centers. Colorectal ESDs with the greatest technical difficulties were mainly performed at the high-volume centers, and there were no significant differences between the high- and low-volume centers with respect to the adverse events. In conclusion, the safety of colorectal ESD in the Hiroshima area was maintained, likely because the cases were allocated and the procedures were undertaken in accordance with the skill level of each hospital and endoscopist.
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