Skip to main content
Erschienen in: Surgical Endoscopy 12/2011

01.12.2011

Endoscopic submucosal dissection versus local excision for early rectal neoplasms: a comparative study

verfasst von: Sophie S. F. Hon, Simon S. M. Ng, Philip W. Y. Chiu, Francis K. L. Chan, Enders K. W. Ng, Jimmy C. M. Li, Janet F. Y. Lee, K. L. Leung

Erschienen in: Surgical Endoscopy | Ausgabe 12/2011

Einloggen, um Zugang zu erhalten

Abstract

Background

Transanal local excision (LE) is a well-established treatment option for early rectal neoplasms not amenable to complete colonoscopic removal. Endoscopic submucosal dissection (ESD) has been introduced recently as a novel procedure that enables en bloc resection of large rectal neoplasms. To date, no report comparing the two approaches can be found in the literature. This study aimed to compare the short-term clinical outcomes between ESD and LE for early rectal neoplasms.

Methods

Between 2007 and 2010, 14 patients with early rectal neoplasms deemed not feasible for en bloc endoscopic resection using conventional techniques underwent ESD. They were compared with a matched cohort of 30 patients who had early rectal neoplasms and underwent LE between 2000 and 2009. Short-term clinical outcomes including postprocedure recovery and morbidity were compared between the two groups.

Results

The mean lesion size was comparable between the ESD and LE groups (2.9 vs 2.6 cm; P = 0.423), but the mean distance of the lesions from the anal verge was greater in the ESD group (8.6 vs 5.0 cm; P = 0.001). En bloc resection was achieved for 12 patients (85.7%) in the ESD group and for all the patients in the LE group. The ESD group exhibited a trend toward a longer operative time (77.5 vs 50.0 min; P = 0.081) but lower morbidity (7.1 vs 33.3%; P = 0.076). The time to full ambulation was shorter in the ESD group (0 vs 1 day; P = 0.005), but the hospital stay was similar in the two groups (2.5 vs 4.0 days; P = 0.129).

Conclusion

For the treatment of early rectal neoplasms, ESD offers better short-term clinical outcomes in terms of faster recovery and possibly lower morbidity than LE. Further prospective studies with a larger sample are needed to validate the benefits of rectal ESD.
Literatur
1.
Zurück zum Zitat Rim SH, Seeff L, Ahmed F, King JB, Coughlin SS (2009) Colorectal cancer incidence in the United States, 1999–2004 : an updated analysis of data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results Program. Cancer 115:1967–1976PubMedCrossRef Rim SH, Seeff L, Ahmed F, King JB, Coughlin SS (2009) Colorectal cancer incidence in the United States, 1999–2004 : an updated analysis of data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results Program. Cancer 115:1967–1976PubMedCrossRef
2.
Zurück zum Zitat Hyodo I, Suzuki H, Takahashi K, Saito Y, Tanaka S, Chiu HM, Kim NK, Li J, Lim R, Villalon A, Boku N (2010) Present status and perspectives of colorectal cancer in Asia: Colorectal Cancer Working Group report in 30th Asia-Pacific Cancer Conference. Jpn J Clin Oncol 40(Suppl 1):i38–i43PubMedCrossRef Hyodo I, Suzuki H, Takahashi K, Saito Y, Tanaka S, Chiu HM, Kim NK, Li J, Lim R, Villalon A, Boku N (2010) Present status and perspectives of colorectal cancer in Asia: Colorectal Cancer Working Group report in 30th Asia-Pacific Cancer Conference. Jpn J Clin Oncol 40(Suppl 1):i38–i43PubMedCrossRef
3.
Zurück zum Zitat Zavoral M, Suchanek S, Zavada F, Dusek L, Muzik J, Seifert B, Fric P (2009) Colorectal cancer screening in Europe. World J Gastroenterol 15:5907–5915PubMedCrossRef Zavoral M, Suchanek S, Zavada F, Dusek L, Muzik J, Seifert B, Fric P (2009) Colorectal cancer screening in Europe. World J Gastroenterol 15:5907–5915PubMedCrossRef
4.
Zurück zum Zitat Hurlstone DP, Cross SS, Adam I, Shorthouse AJ, Brown S, Sanders DS, Lobo AJ (2004) Efficacy of high magnification chromoscopic colonoscopy for the diagnosis of neoplasia in flat and depressed lesions of the colorectum: a prospective analysis. Gut 53:284–290PubMedCrossRef Hurlstone DP, Cross SS, Adam I, Shorthouse AJ, Brown S, Sanders DS, Lobo AJ (2004) Efficacy of high magnification chromoscopic colonoscopy for the diagnosis of neoplasia in flat and depressed lesions of the colorectum: a prospective analysis. Gut 53:284–290PubMedCrossRef
5.
Zurück zum Zitat Middleton PF, Sutherland Lm, Maddern GJ (2005) Transanal endoscopic microsurgery: a systemic review. Dis Col Rectum 48:270–284CrossRef Middleton PF, Sutherland Lm, Maddern GJ (2005) Transanal endoscopic microsurgery: a systemic review. Dis Col Rectum 48:270–284CrossRef
6.
Zurück zum Zitat McCloud JM, Waymont N, Pahwa N, Varghese P, Richards C, Jameson JS, Scott AND (2006) Factors predicting early recurrence after transanal endoscopic microsurgery excision for rectal adenoma. Colorect Dis 8:581–585CrossRef McCloud JM, Waymont N, Pahwa N, Varghese P, Richards C, Jameson JS, Scott AND (2006) Factors predicting early recurrence after transanal endoscopic microsurgery excision for rectal adenoma. Colorect Dis 8:581–585CrossRef
7.
Zurück zum Zitat Casadesus D (2009) Surgical resection of rectal adenoma: a rapid review. World J Gastroenterol 15:3851–3854PubMedCrossRef Casadesus D (2009) Surgical resection of rectal adenoma: a rapid review. World J Gastroenterol 15:3851–3854PubMedCrossRef
8.
Zurück zum Zitat Pigot F, Bouchard D, Mortaji M, Castinel A, Juguet F, Chaume JC, Faivre J (2003) Local excision of large rectal villous adenomas: long-term results. Dis Colon Rectum 46:1345–1350PubMedCrossRef Pigot F, Bouchard D, Mortaji M, Castinel A, Juguet F, Chaume JC, Faivre J (2003) Local excision of large rectal villous adenomas: long-term results. Dis Colon Rectum 46:1345–1350PubMedCrossRef
9.
Zurück zum Zitat Featherstone JM, Grabham JA, Fozard JB (2004) Per-anal excision of large, rectal, villous adenomas. Dis Colon Rectum 47:86–89PubMedCrossRef Featherstone JM, Grabham JA, Fozard JB (2004) Per-anal excision of large, rectal, villous adenomas. Dis Colon Rectum 47:86–89PubMedCrossRef
10.
Zurück zum Zitat Tanaka S, Oka S, Chayama K (2008) Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection. J Gastroenterol 43:641–651PubMedCrossRef Tanaka S, Oka S, Chayama K (2008) Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection. J Gastroenterol 43:641–651PubMedCrossRef
11.
Zurück zum Zitat Saito Y, Fukuzawa M, Matsuda T, Fukunaga S, Sakamota T (2010) Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 24:343–352PubMedCrossRef Saito Y, Fukuzawa M, Matsuda T, Fukunaga S, Sakamota T (2010) Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 24:343–352PubMedCrossRef
12.
Zurück zum Zitat Yoshida N, Wakabayashil N, Kanemasa K (2009) Endoscopic submucosal dissection for colorectal tumors: technical difficulties and rate of perforation. Endoscopy 41:758–761PubMedCrossRef Yoshida N, Wakabayashil N, Kanemasa K (2009) Endoscopic submucosal dissection for colorectal tumors: technical difficulties and rate of perforation. Endoscopy 41:758–761PubMedCrossRef
13.
Zurück zum Zitat Tanaka S, Oka S, Kaneko I, Hirata M, Mouri R, Kanao H, Yoshida S, Chayama K (2007) Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc 66:100–107PubMedCrossRef Tanaka S, Oka S, Kaneko I, Hirata M, Mouri R, Kanao H, Yoshida S, Chayama K (2007) Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc 66:100–107PubMedCrossRef
14.
Zurück zum Zitat Hon SS, Philip CW, Li JC, Lo AW, Ng SS (2010) Endoscopic submucosal dissection of a broad-based rectal polyp (video demonstration). Surg Pract 14:75–76CrossRef Hon SS, Philip CW, Li JC, Lo AW, Ng SS (2010) Endoscopic submucosal dissection of a broad-based rectal polyp (video demonstration). Surg Pract 14:75–76CrossRef
15.
Zurück zum Zitat Buess G, Hutter F, Theiss J, Bobel M, Isslhard W, Pichlmaier H (1984) Das Syste fur die transanale endoskopische Rectumoperation. Chirurg 55:677–680PubMed Buess G, Hutter F, Theiss J, Bobel M, Isslhard W, Pichlmaier H (1984) Das Syste fur die transanale endoskopische Rectumoperation. Chirurg 55:677–680PubMed
16.
Zurück zum Zitat Guerrieri M, Baldarelli M, de Sanctis A, Campagnacci R, Rimini M, Lezoche E (2010) Treatment of rectal adenomas by transanal endoscopic microsurgery: 15 years’ experience. Surg Endosc 24:445–449PubMedCrossRef Guerrieri M, Baldarelli M, de Sanctis A, Campagnacci R, Rimini M, Lezoche E (2010) Treatment of rectal adenomas by transanal endoscopic microsurgery: 15 years’ experience. Surg Endosc 24:445–449PubMedCrossRef
17.
Zurück zum Zitat Yoshida N, Yagi N, Naito Y, Yoshikawa T (2010) Safe procedure in endoscopic submucosal dissection for colorectal tumors focused on preventing complications. World J Gastroenterol 16:1688–1695PubMedCrossRef Yoshida N, Yagi N, Naito Y, Yoshikawa T (2010) Safe procedure in endoscopic submucosal dissection for colorectal tumors focused on preventing complications. World J Gastroenterol 16:1688–1695PubMedCrossRef
18.
Zurück zum Zitat Deprez PH, Bergman JJ, Meisner S, Ponchon T, Repici A, Dinis-Ribeiro M, Haringsma J (2010) Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts. Endoscopy 42:853–858PubMedCrossRef Deprez PH, Bergman JJ, Meisner S, Ponchon T, Repici A, Dinis-Ribeiro M, Haringsma J (2010) Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts. Endoscopy 42:853–858PubMedCrossRef
19.
Zurück zum Zitat Darrah DM, Griebling TL, Silverstein JH (2009) Postoperative urinary retention. Anesthesiol Clin 27:465–484PubMedCrossRef Darrah DM, Griebling TL, Silverstein JH (2009) Postoperative urinary retention. Anesthesiol Clin 27:465–484PubMedCrossRef
20.
Zurück zum Zitat Baldini G, Bagry H, Aprikian A, Carli F (2009) Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology 110:1139–1157PubMedCrossRef Baldini G, Bagry H, Aprikian A, Carli F (2009) Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology 110:1139–1157PubMedCrossRef
Metadaten
Titel
Endoscopic submucosal dissection versus local excision for early rectal neoplasms: a comparative study
verfasst von
Sophie S. F. Hon
Simon S. M. Ng
Philip W. Y. Chiu
Francis K. L. Chan
Enders K. W. Ng
Jimmy C. M. Li
Janet F. Y. Lee
K. L. Leung
Publikationsdatum
01.12.2011
Verlag
Springer-Verlag
Erschienen in
Surgical Endoscopy / Ausgabe 12/2011
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-011-1821-z

Weitere Artikel der Ausgabe 12/2011

Surgical Endoscopy 12/2011 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.