Feasibility of endoscopic submucosal dissection for colorectal neoplasia at anastomotic sites: a retrospective study

Surgical Endoscopy volume 34, pages5495–5500(2020)Cite this article

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.

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Acknowledgements

We gratefully acknowledge the work of past and present members of our division.

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Affiliations

  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

    Tadateru Maehata, Motohiko Kato, Yasutoshi Ochiai, Mari Mizutani, Koshiro Tsutsumi, Yoshiyuki Kiguchi, Teppei Akimoto, Motoki Sasaki, Yusaku Takatori, Atsushi Nakayama & Naohisa Yahagi

  2. Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan

    Kaoru Takabayashi

  3. Department of Gastroenterology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan

    Ai Fujimoto

  4. Department of Gastroenterology, Nippon Medical School, Tokyo, Japan

    Osamu Goto

Authors
  1. Tadateru Maehata
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  2. Motohiko Kato
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  14. Naohisa Yahagi
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Correspondence to Tadateru Maehata.

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Tadateru Maehata, Motohiko Kato, Yasutoshi Ochiai, Mari Mizutani, Koshiro Tsutsumi, Yoshiyuki Kiguchi, Teppei Akimoto, Motoki Sasaki, Yusaku Takatori, Atsushi Nakayama, Kaoru Takabayashi, Ai Fujimoto, Osamu Goto, and Naohisa Yahagi have no conflicts of interest or financial ties to disclose.

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Maehata, T., Kato, M., Ochiai, Y. et al. Feasibility of endoscopic submucosal dissection for colorectal neoplasia at anastomotic sites: a retrospective study. Surg Endosc 34, 5495–5500 (2020). https://doi.org/10.1007/s00464-019-07346-0

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Keywords

  • Endoscopic submucosal dissection
  • Colorectal lesions
  • Anastomotic site