Long-term outcomes of hybrid endoscopic submucosal dissection in a tertiary care center.

BACKGROUND

Hybrid endoscopic submucosal dissection combines elements of endoscopic submucosal dissection and endoscopic mucosal resection to overcome the technical challenges of standard colorectal endoscopic submucosal dissection. It serves as a rescue strategy to facilitate en bloc resection or margin-negative resection when conventional endoscopic submucosal dissection is infeasible. Although short-term benefits are established, long-term data on recurrence and organ preservation remain limited. This study aimed to evaluate the long-term outcomes of hybrid endoscopic submucosal dissection in a large, single-center cohort.

METHODS

Patients who underwent hybrid endoscopic submucosal dissection for colorectal neoplasms between November 2011 and December 2023 were retrospectively analyzed. The primary outcome was recurrence-free survival. Secondary outcomes included en bloc resection rate, R0 resection rate, perioperative complications, operative time, and the need for additional colon resection. Cox proportional hazards regression was used to identify predictors of recurrence-free survival.

RESULTS

A total of 408 lesions from 391 patients were resected using hybrid endoscopic submucosal dissection. The median age was 67 years (IQR, 59-73), and 48.8% were females. The median lesion size was 30 mm (IQR, 20-40); 62.6% were located in the right colon. The en bloc resection rate was 28.9%, and the histologically complete resection rate was 81.4%. Postoperative morbidity occurred in 10.8% of patients. Additional colon resection was required in 4.9% of patients. Among 203 (49.8%) patients who underwent follow-up colonoscopy, the 3-year recurrence-free survival rate was 90.2%. Histologically complete resection was associated with improved recurrence-free survival (hazard ratio [HR], 0.27; 95% CI, 0.11-0.66), whereas older age predicted decreased recurrence-free survival (HR, 1.07; 95% CI, 1.01-1.13).

CONCLUSION

Hybrid endoscopic submucosal dissection is a safe and effective option for the management of complex colorectal lesions, achieving favorable long-term outcomes with a low recurrence rate and a minimal need for surgical resection. Margin-negative resection is critical for oncologic success, and careful postprocedural surveillance remains essential.