Abstract
Endoscopic submucosal dissection (ESD) has been recently introduced as a treatment option for colorectal tumor； however, the efficacy of ESD in treating residual or locally recurrent tumor occurring after endoscopic treatment has not been evaluated. To this effect, in the present study, we assessed the clinical outcomes of colorectal ESD for treating residual or locally recurrent tumor after endoscopic treatment.
Between April 2008 and May 2011, 97 consecutive colorectal tumors in 95 patients were treated using ESD. Of these 6 patients, each with 1 lesion, had residual or locally recurrent tumors with scars after endoscopic treatment (3 recurred after endoscopic mucosal resection, and the other 3 after transanal endoscopic microsurgery) . The rates of both en bloc and curative resection of the 6 lesions were 83.3%. On histological examinations, all lesions showed well-differentiated adenocarcinomas that were confined to the mucosa and had adenomatous components. A piecemeal-resected lesion of 1 patient was observed to be a local recurrence, which was easily treated by hot biopsy. Perforation occurred in 2 cases for which no additional surgical treatment was administered, and no other complications were seen.
Colorectal ESD for residual or locally recurrent tumor with scar occurring after endoscopic treatment is a technically difficult procedure and should be considered carefully when it is weighed with other choices of treatment.
Although we have observed excellent en bloc and curative resection rates, perforation occurred in 2 cases because of the difficulty of the procedure. This finding implies that colorectal ESD for residual or locally recurrent tumors with scars occurring at the same site of a previous endoscopic treatment may be relative indication.
