Endoscopic submucosal dissection in the practice of a coloproctological hospital. The first results of a single-center trial

Fedorenko A.A.; Pavlov P.V.; Kiryukhin A.P.; Tertychnyi A.S.

doi:https://doi.org/10.17116/endoskop20232906152

Fedorenko A.A.

Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0002-1792-5638

Pavlov P.V.

Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0002-4391-5441

Kiryukhin A.P.

Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0001-5685-8784

Tertychnyi A.S.

I.M. Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of Russia

ORCID: 0000-0001-5635-6100

Endoscopic submucosal dissection in the practice of a coloproctological hospital. The first results of a single-center trial

Authors:

Fedorenko A.A., Pavlov P.V., Kiryukhin A.P., Tertychnyi A.S.

More about the authors

Journal: Endoscopic Surgery. 2023;29(6): 52‑61

DOI: 10.17116/endoskop20232906152

Read: 3437 times

Download PDF (RU)

Contact the author

Table of contents

To cite this article:

Fedorenko AA, Pavlov PV, Kiryukhin AP, Tertychnyi AS. Endoscopic submucosal dissection in the practice of a coloproctological hospital. The first results of a single-center trial. Endoscopic Surgery. 2023;29(6):52‑61. (In Russ.)
https://doi.org/10.17116/endoskop20232906152

Подписка 2026 Эндоскопическая хирургия (Endoscopic Surgery)

Использование инфографики авторами научных работ

Close metadata

BACKGROUND

The advantage of endoscopic mucosectomy with submucosal dissection (ESD) is the possibility of achieving “en bloc” resection with a lower rate of local relapses compared to partial endoscopic mucosal resection. When analyzing domestic and international publications according the treatment of early colon cancer, there are contradictions in terms of indications and contraindications for this method of treatment. In our opinion, there are not enough studies evaluating the results of the effectiveness of this intervention.

OBJECTIVE

To present the experience of treating patients with benign and malignant tumors using the method of mucosectomy with dissection in the submucosal layer, carried out in the coloproctology hospital of Sechenov University.

MATERIAL AND METHODS

The experience of treating 156 patients with 157 epithelial neoplasms of the colon and rectum by endoscopic submucosal dissection was analyzed.

RESULTS

Mean age of patients was 64.3±11.4 (M±SD); The average neoplasm size was 44.5±2.9 mm (M±SD); 38.9—50.3 (95% CI). Mean operation time 141.03±11.89 (M±SD); 118.1—163.8 (95% CI). The efficiency of «en bloc» resections and the percentage of complete «en bloc» resections (histologically) were 87.2% (137/157) and 83.4% (131/157) respectively, and the rate of radical (R0) resection was 79% (124/157).

CONCLUSIONS

In our study, 79% of patients received radical endoscopic treatment with a complication rate of 9.4% and a mortality rate of 0%. The obtained results, in general, do not differ significantly from international data, and allow us to state that ESD is a safe and reliable organ-preserving method for the removal of large epithelial neoplasms in the colon.

Keywords:

colon

histology

endoscopic submucosal dissection

endoscopic intermuscular resection

Authors:

Fedorenko A.A.

Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0002-1792-5638

Pavlov P.V.

Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0002-4391-5441

Kiryukhin A.P.

Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0001-5685-8784

Tertychnyi A.S.

I.M. Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of Russia

ORCID: 0000-0001-5635-6100

Received:

17.11.2022

Accepted:

03.10.2023

Close metadata

References:

Hatta W, Gotoda T, Koike T, Masamune A. History and future perspectives in Japanese guidelines for endoscopic resection of early gastric cancer. Dig Endosc. 2020;32(2):180-190. https://doi.org/10.1111/den.13531
Sakamoto T, Mori G, Yamada M, Kinjo Y, So E, Abe S, Otake Y, Nakajima T, Matsuda T, Saito Y. Endoscopic submucosal dissection for colorectal neoplasms: a review. World J Gastroenterol. 2014;20(43):16153-16158. https://doi.org/10.3748/wjg.v20.i43.16153
Yeh JH, Tseng CH, Huang RY, Lin CW, Lee CT, Hsiao PJ, Wu TC, Kuo LT, Wang WL. Long-term Outcomes of Primary Endoscopic Resection vs Surgery for T1 Colorectal Cancer: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2020;18(12):2813-2823.e5. https://doi.org/10.1016/j.cgh.2020.05.060
Ikematsu H, Yoda Y, Matsuda T, Yamaguchi Y, Hotta K, Kobayashi N, Fujii T, Oono Y, Sakamoto T, Nakajima T, Takao M, Shinohara T, Murakami Y, Fujimori T, Kaneko K, Saito Y. Long-term outcomes after resection for submucosal invasive colorectal cancers. Gastroenterology. 2013;144(3):551-559; quiz e14. https://doi.org/10.1053/j.gastro.2012.12.003
Yoshii S, Nojima M, Nosho K, Omori S, Kusumi T, Okuda H, Tsukagoshi H, Fujita M, Yamamoto H, Hosokawa M. Factors associated with risk for colorectal cancer recurrence after endoscopic resection of T1 tumors. Clin Gastroenterol Hepatol. 2014;12(2):292-302.e3. https://doi.org/10.1016/j.cgh.2013.08.008
The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon Participants in the Paris Workshop. Gastrointest Endosc. 2003;58(6 suppl):3-43. https://doi.org/10.1016/s0016-5107(03)02159-x
Tanaka S, Kashida H, Saito Y, Yahagi N, Yamano H, Saito S, Hisabe T, Yao T, Watanabe M, Yoshida M, Saitoh Y, Tsuruta O, Sugihara KI, Igarashi M, Toyonaga T, Ajioka Y, Kusunoki M, Koike K, Fujimoto K, Tajiri H. Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc. 2020;32(2):219-239. https://doi.org/10.1111/den.13545
WHO Classification of Tumors Editorial Board. Digestive system tumors. 5th ed. Lyon (France): IARC; 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003895/
Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline — Update 2022 Authors: Pedro Pimentel-Nunes, Diogo Libânio, Barbara A.J. Bastiaansen, Pradeep Bhandari, Raf Bisschops, Michael J. Bourke, Gianluca Esposito, Arnaud Lemmers, Roberta Maselli, Helmut Messmann, Oliver Pech, Mathieu Pioche, Michael Vieth, Bas L.A.M. Weusten, Jeanin E. van Hooft, Pierre H. Deprez, Mario Dinis-Ribeiro https://www.esge.com/endoscopic-submucosal-dissection-update-2022/
Yatsuoka T, Nishimura Y, Sakamoto H, Tanaka Y, Kurozumi M. [Lymph node metastasis of colorectal cancer with submucosal invasion]. Gan To Kagaku Ryoho. 2013;40(12):2041-2043. (Japanese). https://pubmed.ncbi.nlm.nih.gov/24394006/
Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, Repici A, Vieth M, De Ceglie A, Amato A, Berr F, Bhandari P, Bialek A, Conio M, Haringsma J, Langner C, Meisner S, Messmann H, Morino M, Neuhaus H, Piessevaux H, Rugge M, Saunders BP, Robaszkiewicz M, Seewald S, Kashin S, Dumonceau JM, Hassan C, Deprez PH. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015;47(9):829-854. https://doi.org/10.1055/s-0034-1392882
Daoud DC, Suter N, Durand M, Bouin M, Faulques B, von Renteln D. Comparing outcomes for endoscopic submucosal dissection between Eastern and Western countries: A systematic review and meta-analysis. World J Gastroenterol. 2018;24(23):2518-2536. https://doi.org/10.3748/wjg.v24.i23.2518
Moreira P, Cardoso PM, Macedo G, Santos-Antunes J. Endoscopic Submucosal Dissection, Endoscopic Mucosal Resection, and Transanal Minimally Invasive Surgery for the Management of Rectal and Anorectal Lesions: A Narrative Review. J Clin Med. 2023;12(14):4777. https://doi.org/10.3390/jcm12144777
Khalin KD, Agapov MYu, Zvereva LV. Diagnostic value of preoperative biopsy in differential diagnosis of epithelial colorectal tumors. Pacific Med J. 2018;1:41-43. (In Russ.). https://doi.org/10.17238/PmJ1609-1175.2018.1.41-43
Terasaki M, Tanaka S, Oka S, Nakadoi K, Takata S, Kanao H, Yoshida S, Chayama K. Clinical outcomes of endoscopic submucosal dissection and endoscopic mucosal resection for laterally spreading tumors larger than 20 mm. J Gastroenterol Hepatol. 2012;27(4):734-740. https://doi.org/10.1111/j.1440-1746.2011.06977.x
Kikuchi R, Takano M, Takagi K, Fujimoto N, Nozaki R, Fujiyoshi T, Uchida Y. Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum. 1995;38(12):1286-1295. https://doi.org/10.1007/BF02049154
Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum. 2002;45(2):200-206. https://doi.org/10.1007/s10350-004-6147-7
Sakamoto T, Takamaru H, Mori G, Yamada M, Kinjo Y, So E, Abe S, Otake Y, Nakajima T, Matsuda T, Saito Y. Endoscopic submucosal dissection for colorectal neoplasms. Ann Transl Med. 2014;2(3):26. https://doi.org/10.3978/j.issn.2305-5839.2014.03.02
Rahmi G, Hotayt B, Chaussade S, Lepilliez V, Giovannini M, Coumaros D, Charachon A, Cholet F, Laquière A, Samaha E, Prat F, Ponchon T, Bories E, Robaszkiewicz M, Boustière C, Cellier C. Endoscopic submucosal dissection for superficial rectal tumors: prospective evaluation in France. Endoscopy. 2014;46(8):670-676. https://doi.org/10.1055/s-0034-1365810
Thorlacius H, Rönnow CF, Toth E. European experience of colorectal endoscopic submucosal dissection: a systematic review of clinical efficacy and safety. Acta Oncol. 2019;58(suppl 1):10-14. https://doi.org/10.1080/0284186X.2019.1568547
Draganov PV, Aihara H, Karasik MS, Ngamruengphong S, Aadam AA, Othman MO, Sharma N, Grimm IS, Rostom A, Elmunzer BJ, Jawaid SA, Westerveld D, Perbtani YB, Hoffman BJ, Schlachterman A, Siegel A, Coman RM, Wang AY, Yang D. Endoscopic Submucosal Dissection in North America: A Large Prospective Multicenter Study. Gastroenterology. 2021;160(7):2317-2327.e2. https://doi.org/10.1053/j.gastro.2021.02.036
Makino T, Kanmura S, Sasaki F, Nasu Y, Funakawa K, Tanaka A, Arima S, Nakazawa J, Taguchi H, Hashimoto S, Numata M, Uto H, Tsubouchi H, Ido A. Preoperative classification of submucosal fibrosis in colorectal laterally spreading tumors by endoscopic ultrasonography. Endosc Int Open. 2015;3(4):E363-367. https://doi.org/10.1055/s-0034-1391782
Moons LMG, Bastiaansen BAJ, Richir MC, Hazen WL, Tuynman J, Elias SG, Schrauwen RWM, Vleggaar FP, Dekker E, Bos P, Fariña Sarasqueta A, Lacle M, Hompes R, Didden P. Endoscopic intermuscular dissection for deep submucosal invasive cancer in the rectum: a new endoscopic approach. Endoscopy. 2022;54(10):993-998. https://doi.org/10.1055/a-1748-8573