Recurrence rates after piecemeal endoscopic mucosal resection of large colorectal laterally spreading tumors.

Autor: Michielan A; Gastroenterology and Digestive Endoscopy Unit, Department of Surgery, Santa Chiara Hospital, Trento (Andrea Michielan, Elettra Merola, Filippo Vieceli, Teresa Marzia Rogger, Federica Crispino, Giovanni de Pretis, Nicolò de Pretis)., Merola E; Gastroenterology and Digestive Endoscopy Unit, Department of Surgery, Santa Chiara Hospital, Trento (Andrea Michielan, Elettra Merola, Filippo Vieceli, Teresa Marzia Rogger, Federica Crispino, Giovanni de Pretis, Nicolò de Pretis)., Vieceli F; Gastroenterology and Digestive Endoscopy Unit, Department of Surgery, Santa Chiara Hospital, Trento (Andrea Michielan, Elettra Merola, Filippo Vieceli, Teresa Marzia Rogger, Federica Crispino, Giovanni de Pretis, Nicolò de Pretis)., Rogger TM; Gastroenterology and Digestive Endoscopy Unit, Department of Surgery, Santa Chiara Hospital, Trento (Andrea Michielan, Elettra Merola, Filippo Vieceli, Teresa Marzia Rogger, Federica Crispino, Giovanni de Pretis, Nicolò de Pretis)., Crispino F; Gastroenterology and Digestive Endoscopy Unit, Department of Surgery, Santa Chiara Hospital, Trento (Andrea Michielan, Elettra Merola, Filippo Vieceli, Teresa Marzia Rogger, Federica Crispino, Giovanni de Pretis, Nicolò de Pretis).; Section of Gastroenterology and Hepatology, PROMISE, University of Palermo (Federica Crispino)., Sartori C; Surgical Pathology Unit, Department of Laboratory Medicine, Santa Chiara Hospital, Trento (Chiara Sartori, Nicola Libertà Decarli)., Decarli NL; Surgical Pathology Unit, Department of Laboratory Medicine, Santa Chiara Hospital, Trento (Chiara Sartori, Nicola Libertà Decarli).; Pathology Unit, San Giovanni di Dio Hospital, Firenze (Nicola Libertà Decarli)., de Pretis G; Gastroenterology and Digestive Endoscopy Unit, Department of Surgery, Santa Chiara Hospital, Trento (Andrea Michielan, Elettra Merola, Filippo Vieceli, Teresa Marzia Rogger, Federica Crispino, Giovanni de Pretis, Nicolò de Pretis)., de Pretis N; Gastroenterology and Digestive Endoscopy Unit, Department of Surgery, Santa Chiara Hospital, Trento (Andrea Michielan, Elettra Merola, Filippo Vieceli, Teresa Marzia Rogger, Federica Crispino, Giovanni de Pretis, Nicolò de Pretis).; Gastroenterology B Unit, Department of Medicine, The Pancreas Institute, University and Hospital Trust of Verona (Nicolò de Pretis), Italy.
Jazyk: angličtina
Zdroj: Annals of gastroenterology [Ann Gastroenterol] 2023 Mar-Apr; Vol. 36 (2), pp. 195-202. Date of Electronic Publication: 2023 Jan 20.
DOI: 10.20524/aog.2023.0774
Abstrakt: Background: Piecemeal endoscopic mucosal resection (pEMR) is routinely employed for large laterally spreading tumors (LSTs). Recurrence rates following pEMR are still unclear, especially when cap-assisted EMR (EMR-c) is performed. We assessed the recurrence rates and recurrence risk factors post-pEMR for large colorectal LSTs, including both wide-field EMR (WF-EMR) and EMR-c.
Methods: This was a single-center, retrospective study of consecutive patients who underwent pEMR for colorectal LSTs ≥20 mm at our institution between 2012 and 2020. Patients had a post-resection follow-up period of at least 3 months. A risk factor analysis was carried out using the Cox regression model.
Results: The analysis included 155 pEMR: 51 WF-EMR and 104 EMR-c, with a median lesion size of 30 (range: 20-80) mm and a median endoscopic follow up of 15 (range: 3-76) months. Overall, disease recurrence occurred in 29.0% of cases; there was no significant difference in recurrence rates between WF-EMR and EMR-c. Recurrent lesions were safely managed by endoscopic removal, and at risk analysis lesion size was the only significant risk factor for recurrence (mm; hazard ratio 1.03, 95% confidence interval 1.00-1.06, P=0.02).
Conclusions: Recurrence of large colorectal LSTs after pEMR occurs in 29% of cases. This rate is mainly dependent on lesion size, and the use of a cap during pEMR has no effect on recurrence. Prospective controlled trials are needed to validate these results.
Competing Interests: Conflict of Interest: None
(Copyright: © Hellenic Society of Gastroenterology.)
Databáze: MEDLINE
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