Long-term local recurrence and survival after colorectal endoscopic submucosal dissection: a prospective multicenter real-world cohort study.
Masachika Saino, Toshio Kuwai, Yuki Kamigaichi et al.
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In 30 seconds
This prospective, multicenter real-world cohort study assessed long-term local recurrence and survival after colorectal endoscopic submucosal dissection (ESD) at 11 institutions in Japan. It included 1838 lesions from 1732 patients treated between 2014 and 2018. Cumulative local recurrence was 0.06% at 1 year, 0.64% at 3 years, and 0.75% at 5 years; no recurrence was observed after curative resection. Rectal location, high-risk pathology, R1 resection, and delayed bleeding were associated with recurrence. Five-year overall survival was 95.3%, and cancer-specific survival was 100%.
Key findings
- Cumulative local recurrence rates were 0.06%, 0.64%, and 0.75% at 1, 3, and 5 years, respectively.
- No local recurrence occurred among patients with curative resection; the longest interval to recurrence was 52 months.
- Recurrence was associated with rectal lesions (HR 3.93; P = 0.04), high-risk pathologic features (HR 14.3; P < 0.001), R1 resection (HR 7.59; P = 0.003), and delayed bleeding (HR 7.72; P = 0.009).
- Five-year overall survival was 95.3% and cancer-specific survival was 100%; one of 10 patients with recurrence developed metastases and died 64 months after ESD.
Why it matters
The findings indicate that local recurrence after colorectal ESD was uncommon in this multicenter real-world cohort, particularly after curative resection. Recurrence was associated with noncurative or higher-risk features, and it could occur years after treatment. These results help frame the importance of resection status and long-term outcome monitoring when assessing ESD results.
What to keep in mind
The study was conducted at 11 institutions in Hiroshima, Japan, so its findings may not generalize to all settings.