Local recurrence after endoscopic resection for large colorectal neoplasia

A multicenter prospective study in Japan

Shiro Oka, Shinji Tanaka, Yutaka Saito, Hiroyasu Iishi, Shin Ei Kudo, Hiroaki Ikematsu, Masahiro Igarashi, Yusuke Saitoh, Yuji Inoue, Kiyonori Kobayashi, Takashi Hisabe, Osamu Tsuruta, Yasushi Sano, Hiroo Yamano, Seiji Shimizu, Naohisa Yahagi, Toshiaki Watanabe, Hisashi Nakamura, Takahiro Fujii, Hideki Ishikawa & 1 others Kenichi Sugihara

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

OBJECTIVES:Conventional endoscopic resection (CER) is a widely accepted treatment for early colorectal neoplasia; however, large colorectal neoplasias remain problematic, as they necessitate piecemeal resection, increasing the risk of local recurrence. Endoscopic submucosal dissection (ESD) can improve the en bloc resection rate. This study aimed to evaluate local recurrence and its associated risk factors after endoscopic resection (ER) for colorectal neoplasias ≥20 mm.METHODS:A multicenter prospective study at 18 medium-and high-volume specialized institutions was conducted in Japan. Follow-up colonoscopy was performed after 12 months in cases of complete resection and after 3-6 months in cases of incomplete resection. Local recurrence was confirmed by endoscopic findings and/or pathological analysis.RESULTS:Follow-up colonoscopy was performed in 1,524 of 1,845 enrolled colorectal neoplasias (mean age, 65 years; 885 men; median tumor size, 32.8 mm). The local recurrence rates were 4.3% (65/1,524), 6.8% (55/808), and 1.4% (10/716) for the entire cohort, for CER, and for ESD, respectively. The relative risks of local recurrence were 0.21 (95% confidence interval, 0.11-0.39) with ESD compared with CER, 0.32 (95% confidence interval, 0.11-0.92) with en bloc ESD compared with en bloc CER, and 0.90 (95% confidence interval, 0.39-2.12) with piecemeal ESD compared with piecemeal CER. Significant factors associated with local recurrence were piecemeal resection, laterally spreading tumors of granular type, tumor size ≥40 mm, no pre-treatment magnification, and ≤10 years of experience in CER, and piecemeal resection only in ESD.CONCLUSIONS:En bloc ESD reduces the local recurrence rate for large colorectal neoplasias. Piecemeal resection is the most important risk factor for local recurrence regardless of the ER method used.

Original languageEnglish
Pages (from-to)697-707
Number of pages11
JournalAmerican Journal of Gastroenterology
Volume110
Issue number5
DOIs
Publication statusPublished - 2015 May 8

Fingerprint

Multicenter Studies
Japan
Prospective Studies
Recurrence
Neoplasms
Confidence Intervals
Colonoscopy
Endoscopic Mucosal Resection
Therapeutics

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Local recurrence after endoscopic resection for large colorectal neoplasia : A multicenter prospective study in Japan. / Oka, Shiro; Tanaka, Shinji; Saito, Yutaka; Iishi, Hiroyasu; Kudo, Shin Ei; Ikematsu, Hiroaki; Igarashi, Masahiro; Saitoh, Yusuke; Inoue, Yuji; Kobayashi, Kiyonori; Hisabe, Takashi; Tsuruta, Osamu; Sano, Yasushi; Yamano, Hiroo; Shimizu, Seiji; Yahagi, Naohisa; Watanabe, Toshiaki; Nakamura, Hisashi; Fujii, Takahiro; Ishikawa, Hideki; Sugihara, Kenichi.

In: American Journal of Gastroenterology, Vol. 110, No. 5, 08.05.2015, p. 697-707.

Research output: Contribution to journalArticle

Oka, S, Tanaka, S, Saito, Y, Iishi, H, Kudo, SE, Ikematsu, H, Igarashi, M, Saitoh, Y, Inoue, Y, Kobayashi, K, Hisabe, T, Tsuruta, O, Sano, Y, Yamano, H, Shimizu, S, Yahagi, N, Watanabe, T, Nakamura, H, Fujii, T, Ishikawa, H & Sugihara, K 2015, 'Local recurrence after endoscopic resection for large colorectal neoplasia: A multicenter prospective study in Japan', American Journal of Gastroenterology, vol. 110, no. 5, pp. 697-707. https://doi.org/10.1038/ajg.2015.96
Oka, Shiro ; Tanaka, Shinji ; Saito, Yutaka ; Iishi, Hiroyasu ; Kudo, Shin Ei ; Ikematsu, Hiroaki ; Igarashi, Masahiro ; Saitoh, Yusuke ; Inoue, Yuji ; Kobayashi, Kiyonori ; Hisabe, Takashi ; Tsuruta, Osamu ; Sano, Yasushi ; Yamano, Hiroo ; Shimizu, Seiji ; Yahagi, Naohisa ; Watanabe, Toshiaki ; Nakamura, Hisashi ; Fujii, Takahiro ; Ishikawa, Hideki ; Sugihara, Kenichi. / Local recurrence after endoscopic resection for large colorectal neoplasia : A multicenter prospective study in Japan. In: American Journal of Gastroenterology. 2015 ; Vol. 110, No. 5. pp. 697-707.
@article{60a352854f024edf910e46bb6227d701,
title = "Local recurrence after endoscopic resection for large colorectal neoplasia: A multicenter prospective study in Japan",
abstract = "OBJECTIVES:Conventional endoscopic resection (CER) is a widely accepted treatment for early colorectal neoplasia; however, large colorectal neoplasias remain problematic, as they necessitate piecemeal resection, increasing the risk of local recurrence. Endoscopic submucosal dissection (ESD) can improve the en bloc resection rate. This study aimed to evaluate local recurrence and its associated risk factors after endoscopic resection (ER) for colorectal neoplasias ≥20 mm.METHODS:A multicenter prospective study at 18 medium-and high-volume specialized institutions was conducted in Japan. Follow-up colonoscopy was performed after 12 months in cases of complete resection and after 3-6 months in cases of incomplete resection. Local recurrence was confirmed by endoscopic findings and/or pathological analysis.RESULTS:Follow-up colonoscopy was performed in 1,524 of 1,845 enrolled colorectal neoplasias (mean age, 65 years; 885 men; median tumor size, 32.8 mm). The local recurrence rates were 4.3{\%} (65/1,524), 6.8{\%} (55/808), and 1.4{\%} (10/716) for the entire cohort, for CER, and for ESD, respectively. The relative risks of local recurrence were 0.21 (95{\%} confidence interval, 0.11-0.39) with ESD compared with CER, 0.32 (95{\%} confidence interval, 0.11-0.92) with en bloc ESD compared with en bloc CER, and 0.90 (95{\%} confidence interval, 0.39-2.12) with piecemeal ESD compared with piecemeal CER. Significant factors associated with local recurrence were piecemeal resection, laterally spreading tumors of granular type, tumor size ≥40 mm, no pre-treatment magnification, and ≤10 years of experience in CER, and piecemeal resection only in ESD.CONCLUSIONS:En bloc ESD reduces the local recurrence rate for large colorectal neoplasias. Piecemeal resection is the most important risk factor for local recurrence regardless of the ER method used.",
author = "Shiro Oka and Shinji Tanaka and Yutaka Saito and Hiroyasu Iishi and Kudo, {Shin Ei} and Hiroaki Ikematsu and Masahiro Igarashi and Yusuke Saitoh and Yuji Inoue and Kiyonori Kobayashi and Takashi Hisabe and Osamu Tsuruta and Yasushi Sano and Hiroo Yamano and Seiji Shimizu and Naohisa Yahagi and Toshiaki Watanabe and Hisashi Nakamura and Takahiro Fujii and Hideki Ishikawa and Kenichi Sugihara",
year = "2015",
month = "5",
day = "8",
doi = "10.1038/ajg.2015.96",
language = "English",
volume = "110",
pages = "697--707",
journal = "American Journal of Gastroenterology",
issn = "0002-9270",
publisher = "Nature Publishing Group",
number = "5",

}

TY - JOUR

T1 - Local recurrence after endoscopic resection for large colorectal neoplasia

T2 - A multicenter prospective study in Japan

AU - Oka, Shiro

AU - Tanaka, Shinji

AU - Saito, Yutaka

AU - Iishi, Hiroyasu

AU - Kudo, Shin Ei

AU - Ikematsu, Hiroaki

AU - Igarashi, Masahiro

AU - Saitoh, Yusuke

AU - Inoue, Yuji

AU - Kobayashi, Kiyonori

AU - Hisabe, Takashi

AU - Tsuruta, Osamu

AU - Sano, Yasushi

AU - Yamano, Hiroo

AU - Shimizu, Seiji

AU - Yahagi, Naohisa

AU - Watanabe, Toshiaki

AU - Nakamura, Hisashi

AU - Fujii, Takahiro

AU - Ishikawa, Hideki

AU - Sugihara, Kenichi

PY - 2015/5/8

Y1 - 2015/5/8

N2 - OBJECTIVES:Conventional endoscopic resection (CER) is a widely accepted treatment for early colorectal neoplasia; however, large colorectal neoplasias remain problematic, as they necessitate piecemeal resection, increasing the risk of local recurrence. Endoscopic submucosal dissection (ESD) can improve the en bloc resection rate. This study aimed to evaluate local recurrence and its associated risk factors after endoscopic resection (ER) for colorectal neoplasias ≥20 mm.METHODS:A multicenter prospective study at 18 medium-and high-volume specialized institutions was conducted in Japan. Follow-up colonoscopy was performed after 12 months in cases of complete resection and after 3-6 months in cases of incomplete resection. Local recurrence was confirmed by endoscopic findings and/or pathological analysis.RESULTS:Follow-up colonoscopy was performed in 1,524 of 1,845 enrolled colorectal neoplasias (mean age, 65 years; 885 men; median tumor size, 32.8 mm). The local recurrence rates were 4.3% (65/1,524), 6.8% (55/808), and 1.4% (10/716) for the entire cohort, for CER, and for ESD, respectively. The relative risks of local recurrence were 0.21 (95% confidence interval, 0.11-0.39) with ESD compared with CER, 0.32 (95% confidence interval, 0.11-0.92) with en bloc ESD compared with en bloc CER, and 0.90 (95% confidence interval, 0.39-2.12) with piecemeal ESD compared with piecemeal CER. Significant factors associated with local recurrence were piecemeal resection, laterally spreading tumors of granular type, tumor size ≥40 mm, no pre-treatment magnification, and ≤10 years of experience in CER, and piecemeal resection only in ESD.CONCLUSIONS:En bloc ESD reduces the local recurrence rate for large colorectal neoplasias. Piecemeal resection is the most important risk factor for local recurrence regardless of the ER method used.

AB - OBJECTIVES:Conventional endoscopic resection (CER) is a widely accepted treatment for early colorectal neoplasia; however, large colorectal neoplasias remain problematic, as they necessitate piecemeal resection, increasing the risk of local recurrence. Endoscopic submucosal dissection (ESD) can improve the en bloc resection rate. This study aimed to evaluate local recurrence and its associated risk factors after endoscopic resection (ER) for colorectal neoplasias ≥20 mm.METHODS:A multicenter prospective study at 18 medium-and high-volume specialized institutions was conducted in Japan. Follow-up colonoscopy was performed after 12 months in cases of complete resection and after 3-6 months in cases of incomplete resection. Local recurrence was confirmed by endoscopic findings and/or pathological analysis.RESULTS:Follow-up colonoscopy was performed in 1,524 of 1,845 enrolled colorectal neoplasias (mean age, 65 years; 885 men; median tumor size, 32.8 mm). The local recurrence rates were 4.3% (65/1,524), 6.8% (55/808), and 1.4% (10/716) for the entire cohort, for CER, and for ESD, respectively. The relative risks of local recurrence were 0.21 (95% confidence interval, 0.11-0.39) with ESD compared with CER, 0.32 (95% confidence interval, 0.11-0.92) with en bloc ESD compared with en bloc CER, and 0.90 (95% confidence interval, 0.39-2.12) with piecemeal ESD compared with piecemeal CER. Significant factors associated with local recurrence were piecemeal resection, laterally spreading tumors of granular type, tumor size ≥40 mm, no pre-treatment magnification, and ≤10 years of experience in CER, and piecemeal resection only in ESD.CONCLUSIONS:En bloc ESD reduces the local recurrence rate for large colorectal neoplasias. Piecemeal resection is the most important risk factor for local recurrence regardless of the ER method used.

UR - http://www.scopus.com/inward/record.url?scp=84928927808&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84928927808&partnerID=8YFLogxK

U2 - 10.1038/ajg.2015.96

DO - 10.1038/ajg.2015.96

M3 - Article

VL - 110

SP - 697

EP - 707

JO - American Journal of Gastroenterology

JF - American Journal of Gastroenterology

SN - 0002-9270

IS - 5

ER -