This is a retrospective study from 15 Western centers performing colorectal endoscopic submucosal dissection (ESD) in Europe and Australia. <\/p>\n\n\n\n
A curative resection was defined as R0, only mucosal disease or superficial submucosal invasion (SMI <1000 microns), well or moderately differentiated, and without lymphovascular invasion (LVI). All other resections and those presenting with tumor budding were considered noncurative. <\/p>\n\n\n\n
Among 2255 colorectal ESDs, there were 381 noncurative resections, of which 352 received either surgery or at least one follow-up endoscopy. Of these, 135 were T1 cancers, including 60 colonic and 75 rectal. <\/p>\n\n\n\n
Eight patients refused surgery, 15 had indications for surgery but were too ill, and 96 (71%) underwent surgery. One patient died from surgical complications, and the median endoscopic follow-up of patients who did not undergo surgery was 12 months.<\/p>\n\n\n\n
Of the 135 patients with malignant lesions, 17 (13%) had superficial SMI, and none of these patients had lymph node-positive or residual disease in the bowel wall, regardless of other risk factors. The remainder of patients had deeper SMI, and residual disease was discovered in 24% of these patients. However, in the absence of poor differentiation, positive horizontal or vertical margins, and LVI, the risk of lymph node metastasis (LNM) or residual wall lesion was also 0%. <\/p>\n\n\n\n
The authors developed a predictive score for LNM. Lymphatic invasion was scored with 2 points, and poor differentiation received 1 point. These were the only two factors that predicted LNM after logistic regression. For scores of 0, 1, 2, and 3, the risk rates of positive lymph nodes were 6%, 25%, 30%, and 75%, respectively.<\/p>\n\n\n\n
Risk factors for residual disease in the bowel wall were piecemeal resection, poor differentiation, and positive or uncertain vertical margin. Based on multivariate analysis, a score of 1 was assigned to poor differentiation and a score of 2 was assigned for piecemeal resection, involved vertical margin, or unknown vertical margin. For scores of 0, 1 to 3, and >3, the risk of residual disease in the bowel wall was 2%, 18%, and 50%, respectively.<\/p>\n","protected":false},"excerpt":{"rendered":"
This is a retrospective study from 15 Western centers performing colorectal endoscopic submucosal dissection (ESD) in Europe and Australia. A curative resection was defined as R0, only mucosal disease or superficial submucosal invasion (SMI <1000 microns), well or moderately differentiated, and without lymphovascular invasion (LVI). All other resections and those presenting with tumor budding were … Read more<\/a><\/p>\n","protected":false},"template":"","categories":[1768,1769],"tags":[2058,785,267,2772,3099,3396,3098],"class_list":["post-12436","ec-news","type-ec-news","status-publish","hentry","category-asge-journal-scan","category-asge-kolon","tag-colon-2","tag-endoscopic-submucosal-dissection","tag-esd","tag-lnm","tag-lvi","tag-lymph-node-metastasis","tag-lymphovascular-invasion"],"_links":{"self":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/ec-news\/12436","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/ec-news"}],"about":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/types\/ec-news"}],"wp:attachment":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/media?parent=12436"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/categories?post=12436"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/tags?post=12436"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}