Is Additional Surgery Necessary After Non-Curative Endoscopic Submucosal Dissection for Early Colorectal Cancer?

Abstract

Background

Although endoscopic submucosal dissection (ESD) is considered to be a curative treatment for early colorectal cancer, additional surgery with lymph node dissection is routinely recommended for patients treated in non-curative ESD, owing to the risk of residual cancer and lymph node metastasis (LNM). However, in clinical practice, few patients are found to have either residual cancer or LNM after additional surgery. Therefore, we conducted this study to determine the risk factors associated with residual cancer and LNM.

Methods

Patients with early colorectal cancer after non-curative ESD and additional surgery from January 2015 to May 2019 were retrospectively identified. Clinicopathological characteristics were collected to determine the predictors of residual cancer and LNM.

Results

A total of 62 patients were enrolled for analysis in this study. After additional surgery, residual cancer and LNM was detected in 12 patients (19.35%). Clinicopathological comparison of patients with the presence or absence of residual cancer and LNM demonstrated that piecemeal resection (80% vs. 14.04%, P < 0.001), submucosal invasion greater than 2000 μm (26.09% vs. 0%, P = 0.026), lymphovascular infiltration (37.5% vs. 13.04%, P = 0.033), and perineuronal invasion (75% vs. 15.52%, P = 0.004) were more frequent in residual cancer and LNM cases. Multivariate analysis identified lymphovascular infiltration (P = 0.031) as the only significantly independent risk factor associated with residual cancer and LNM.

Conclusions

Additional surgery with lymphadenectomy should be performed after non-curative ESD owing to the high risk of residual cancer and LNM, especially in cases with lymphovascular infiltration.

Keywords:

• Endoscopic submucosal dissection
• Additional surgery
• Colorectal cancer

This article is referred to by:

Requirement of Additional Surgery after Non-Curative Endoscopic Submucosal Dissection for Early Colorectal Cancer

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

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

Additional information

Funding

This work was supported by National Key R&D Program of China (No. 2017YFC0908200, and No 2017YFC0908203), CAMS Initiative for Innovative Medicine (No. CAMS-I2M-003), and Science and Technology Project of Chaoyang District, Beijing (No. CYSF-1931).