AI Article Synopsis
- - This study evaluates the effectiveness and safety of endoscopic submucosal dissection (ESD) for treating laterally spreading tumors involving the dentate line (LST-DL) compared to those not involving it (LST-NDL).
- - A total of 49 patients with LST-DL and 96 with LST-NDL were analyzed; results showed similar en bloc resection rates but longer procedure times and higher complications like perianal pain for LST-DL cases.
- - The findings suggest that while ESD is a safe and effective option for LST-DL, it requires skilled endoscopists due to its complexities.
Article Abstract
Objective: Endoscopic submucosal dissection (ESD) for laterally spreading tumors (LST) involving the dentate line (LST-DL) is challenging because of the specific anatomical features of the anorectum. This study aimed to evaluate the efficacy and safety of ESD for LST-DL.
Methods: Consecutive patients with LST-DL who had undergone ESD at our hospital between January 2010 and December 2015 were retrospectively enrolled in this study. Rates of en bloc resection, R0 resection, and complications, pathological characteristics, and tumor recurrence were analyzed and compared with those of LST in the rectum not involving the dentate line (LST-NDL).
Results: Altogether 49 patients with LST-DL (median age 63 years; 39 women; median lesion size 57 mm; median follow-up period of 24 months) and 96 patients with LST-NDL (median age 67 years; 31 women; median lesion size 47 mm; median follow-up period of 31 months) were enrolled. En bloc resection (93.9% [46/49] vs 94.8% [91/96]) and en bloc R0 resection rates (83.7% [41/49] vs 88.5% [85/96]), respectively, for LST-DL and LST-NDL, with no significant differences. However, ESD for LST-DL had a longer procedure time (77 min vs 54 min, P = 0.02), a greater postprocedural perianal pain rate (28.6% vs 0%, P < 0.001), and more anal strictures (4.1% vs 0%, P = 0.04). The complication rates of perforation, bleeding and fever, recurrence rate, and pathological characteristics did not differ between the two groups.
Conclusions: ESD is a safe and effective therapeutic modality for LST-DL. However, this procedure should be performed by experienced endoscopists and the difficulty needs to be fully considered.
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| http://dx.doi.org/10.1111/1751-2980.12701 | DOI Listing |
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