Endoscopic Submucosal Dissection for Resections Larger than 10 cm: Outcomes from a Portuguese Center.

Autor:	Mendes RR; Gastroenterology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal., Barreiro P; Gastroenterology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.; Lisbon Advanced Endoscopy Center, Hospital Lusíadas, Lisbon, Portugal., Mascarenhas A; Gastroenterology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal., Franco AR; Gastroenterology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal., Carvalho L; Gastroenterology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal., Chagas C; Gastroenterology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
Jazyk:	angličtina
Zdroj:	GE Portuguese journal of gastroenterology [GE Port J Gastroenterol] 2023 Jan 19; Vol. 31 (1), pp. 33-40. Date of Electronic Publication: 2023 Jan 19 (Print Publication: 2024).
DOI:	10.1159/000528102
Abstrakt:	Background: Endoscopic submucosal dissection (ESD) is a minimally invasive technique for en bloc resection of superficial neoplastic lesions, independent of their size. However, for giant gastrointestinal superficial neoplasia, the risk of invasive cancer is higher, and ESD is typically challenging. Despite the increasing literature on giant resections, data on their efficacy and safety are still lacking. Objective: The aim of this study was to describe ESD outcomes from a Portuguese center, compare them with other international studies, and analyze the possible risk factors influencing outcomes. Methods: We conducted a retrospective single-center review using a prospectively collected database, including patients with rectal ESD resections larger than 10 cm, between January 2016 and December 2021. Clinical, procedural, and pathological data were collected and analyzed. Revision of the literature for comparison with international results was done through PubMed. Data were analyzed and statistical analysis performed, using Microsoft Excel and SPSS, to identify significant risk factors. Results: The study included 15 rectal resections, with a mean diameter of 140.9 mm (range 105-270), corresponding to lesions of 125.9 mm (87-238). The overall en bloc resection rate was 100% ( n = 15). According to ESGE criteria, procedure was considered curative in 53.3% ( n = 8), non-curative with high risk in 13.3% ( n = 2), and local-risk recurrence in 33.3% ( n = 5). Adverse events occurred in 26.7% ( n = 4): 1 minor perforation and 3 stenosis, most endoscopically managed. For non-curative resections with local-risk recurrence, surveillance without adjuvant therapy was performed in all cases. For high-risk non-curative resections, surgery was performed in 1 patient and adjuvant chemoradiation therapy in another. Follow-up (mean 16 months) demonstrated a recurrence rate of 0%. Statistical analysis revealed resection size ≥20 cm as a risk factor for perforation ( p value 0.067), and involvement of ≥90% of the circumference and procedural time ≥4 h as risk factors for stenosis ( p value 0.029 and 0.009, respectively). Conclusions: Although challenging, ESD for giant lesions seems effective and safe, with a still relevant rate of complications, which were mostly endoscopically treated. Rigorous characterization of lesions is crucial to predict and avoid complications or the need for therapy escalation. Competing Interests: The authors have no conflicts of interest to declare. (Copyright © 2023 by The Author(s). Published by S. Karger AG, Basel.)
Databáze:	MEDLINE
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