Feasibility of endoscopic submucosal dissection for colorectal neoplasia at anastomotic sites: a retrospective study
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Feasibility of endoscopic submucosal dissection for colorectal neoplasia at anastomotic sites: a retrospective study Tadateru Maehata1 · Motohiko Kato1 · Yasutoshi Ochiai1 · Mari Mizutani1 · Koshiro Tsutsumi1 · Yoshiyuki Kiguchi1 · Teppei Akimoto1 · Motoki Sasaki1 · Yusaku Takatori1 · Atsushi Nakayama1 · Kaoru Takabayashi2 · Ai Fujimoto3 · Osamu Goto4 · Naohisa Yahagi1 Received: 9 October 2019 / Accepted: 24 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Metachronous colorectal lesions sometimes occur at anastomotic sites following colorectal surgery, which increases the risk of developing colorectal cancer. However, these lesions are difficult to treat even with minimally invasive methods such as endoscopic submucosal dissection (ESD). Thus, we aimed to evaluate the outcomes of ESD for colorectal lesions at anastomotic sites following colorectal surgery. Methods We retrospectively investigated 11 patients with post-surgical colorectal lesions at anastomotic sites who later underwent ESD from May 2010 to April 2019 at Keio University Hospital, Tokyo, Japan. We examined the patients’ background (tumor location, macroscopic type, tumor size, histological type, and depth of invasion) and treatment outcomes (procedure duration, en bloc resection rate, R0 resection rate, and adverse events). Results The patients’ mean age was 66 years. There were two lesions in the transverse colon, six in the rectum, one in the anal canal, and two in the ileal pouch. The median tumor size was 25 mm. The macroscopic types were the protruded type (1 lesion) and the flat or depressed type (10 lesions). The pathological diagnoses were adenoma (4 lesions), intramucosal cancer (corresponding to high-grade dysplasia) (6 lesions), and muscularis propria cancer (1 lesion). The median procedure duration was 50 min; en bloc resection rate was 88.9% and R0 resection rate was 66.7%. The only adverse event was delayed post-ESD bleeding. Conclusions A high en bloc resection rate without perforation was achieved with ESD for lesions at anastomotic sites. Although ESD for lesions at anastomotic sites is a technically challenging procedure because of severe submucosal fibrosis, this approach could prevent the need for repeated surgical resection. Keywords Endoscopic submucosal dissection · Colorectal lesions · Anastomotic site Compared to the general population, patients undergoing surgery for colorectal cancer remain at an increased risk of * Tadateru Maehata [email protected] 1
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku‑ku, Tokyo 160‑8582, Japan
2
Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
3
Department of Gastroenterology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
4
Department of Gastroenterology, Nippon Medical School, Tokyo, Japan
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