Risk factors for vertical incomplete resection in endoscopic submucosal dissection of deep invasive submucosal colorectal cancer

Abstract

Introduction

It has been recently reported that deep invasive submucosal (T1b) colorectal cancer (CRC) without other pathological risk factors for lymph node metastasis has a low rate of lymph node metastasis, increasing the possibility of endoscopic submucosal dissection (ESD) in the future. However, ESD for T1b CRC is technically difficult, and some lesions cannot be resected en bloc. This study aimed to identify the risk factors associated with vertical incomplete ESD in T1b CRC.

Methods

We retrospectively studied 140 pathological T1b CRC lesions that underwent initial ESD at our institution between January 2011 and October 2020, and categorized them into positive vertical margin (PVM) and negative vertical margin (NVM) groups. The risk factors for PVM were examined using univariate and multivariate analyses, and a subgroup analysis for T1b CRC with an obvious depressed surface was performed.

Results

Multivariate analysis revealed obvious depression (hazard ratio [HR]: 7.4; 95% confidence interval [CI]: 2.47–22.5) and severe fibrosis (HR: 11.4; 95% CI: 3.95–33.0) as significant risk factors for PVM. Length of depressed surface ≥12 mm (HR: 6.19; 95% CI: 1.56 –24.6) was identified as an independent predictor of PVM for T1b CRC with an obvious depression.

Conclusion

Pathological T1b CRC cases with an obvious depression and severe fibrosis are at a high risk of vertical incomplete ESD.

Keywords:

• Positive vertical margin
• deep invasive submucosal cancer
• endoscopic submucosal dissection
• colorectal cancer
• endoscopic resection

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Acknowledgments

We would like to thank all members of the Department of Pathology and Gastroenterological Surgery for their enthusiastic support.

Ethical approval

Before colorectal ESD, all study patients provided written informed consent, and the study was conducted in accordance with the ethical standards of the 1964 Declaration of Helsinki and its subsequent amendments. The study design was approved by the Institutional Review Board of the Japanese Foundation for Cancer Research (IRB no. 2020-1237).

Author contributions

The paper was coauthored by Akiko Chino, Mitsuaki Ishioka, Keigo Suzuki, Daisuke Ide, Shoichi Saito, Masahiro Igarashi, and Junko Fujisaki. CY was responsible for the design and drafting of the manuscript. MI, KS, and DI were responsible for data retrieval and analysis. AC and MI were responsible for the conception and revision of the manuscript. SS and JF were responsible for the final review and revision of the manuscript and supervision of the study. All authors read and approved the final manuscript.

Disclosure statement

The authors report there are no competing interests to declare.

Data availability statement

The data that support the findings of this study are not publicly available because they contain information that could compromise the privacy of patients; however, they are available from the corresponding author [CV] upon reasonable request.