Large North American Multicenter Experience on Endoscopic Submucosal Dissection of Rectal Neoplasms Extending to the Dentate Line.
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Sharma Neil R, Gopakumar Harishankar, Malik Talia F, Khan Aqsa, Dahiya Dushyant S, Vohra Ishaan, Zelt Christina M, Rumple Ashley, Flanagan Mindy, Mendoza-Ladd Antonio, Adam Abdul A, Saeed Ahmed B, Othman Mohamed, Ngamruengphong Saowanee, Arayakarnkul Suchapa, Bhatt Amit, Yang Dennis, Bilal Mohammad, Rojas De Leon Mariajose, Schlachterman Alexander, Madaka Pranita, Kamal Faisal, Kumar Anand, Thompson Blake, Kedia Prashant, Diehl David, Shah Sagar, Sedarat Alireza, Wang Andrew Y, Dhaliwal Amaninder, Pannu Davinderbir S, Mizrahi Meir, Kahaleh Michel, Andrawes Sherif, Draganov Peter V
Аннотация
METHODS: This is a large-scale multicenter retrospective study of patients who underwent ESD for RNDLs between 2015 and 2023. The primary outcomes were the rates of R0 and en bloc resection. Secondary outcomes were immediate and delayed adverse events.
RESULTS: A total of 255 patients across 20 institutions were included (mean age 63.60, women 52.20%). The median lesion size was 40 mm (IQR: 30 to 55), and the median resection time was 110 minutes (IQR: 81 to 169). The en bloc resection rate was 93.70% (n=236), and the rate of R0 resection was 85.40% (n=216). The rate of overall adverse events was 8.70% (n=22, 95% CI: 5.22% to 12.17%), with 13 cases of bleeding (5.10%), 4 cases of full-thickness perforation, and 1 case of postprocedural pain requiring intervention. All AEs were managed conservatively without the need for subsequent surgical or endoscopic interventions.
CONCLUSIONS: ESD is safe and effective for resecting RNDLs with high en bloc and R0 resection rates, offering the potential for complete resection with minimal morbidity. It offers advantages over TEN, TAMIS, and other forms of transanal surgery due to the anatomy being less conducive to the equipment required for these techniques, lower cost, and lower rates of complications. However, careful patient selection, meticulous procedural planning, and close follow-up are essential to ensure optimal outcomes and minimize the risk of complications. Long-term follow-up studies and additional prospective controlled trials are warranted.