Neoplastic recurrence after colorectal endoscopic submucosal dissection at scheduled endoscopic surveillance: a systematic review and meta-analysis.
Daryl Ramai, Abdulrahman Qatomah, Yizhong Wu et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis assessed neoplastic recurrence at scheduled surveillance after colorectal endoscopic submucosal dissection (ESD), including associations with histology and resection quality. Ten studies covering 5306 lesions were included. Pooled recurrence remained low across follow-up: 1.2% (95%CI 0.4%-2.6%) at 1 year, 1.4% (95%CI 1.0%-1.9%) at 3 years, and 1.9% (95%CI 0.9%-3.1%) at 5 years. Malignant recurrence was rare and occurred in noncurative resections or lesions with deep submucosal invasion. The authors suggest that surveillance intervals up to 5 years may be considered for low-risk patients.
Key findings
- Pooled neoplastic recurrence was 1.2% (95%CI 0.4%-2.6%), 1.4% (95%CI 1.0%-1.9%), and 1.9% (95%CI 0.9%-3.1%) at 1, 3, and 5 years, respectively.
- The pooled R0 resection rate was 82% (95%CI 79%-85%).
- Malignant recurrence was 0.2% and was confined to noncurative resections or lesions with deep submucosal invasion.
- The pooled metachronous lesion rate was 1.4% (95%CI 0.4%-3.0%); limited time-stratified data suggested accumulation during follow-up.
Why it matters
These pooled estimates indicate that recurrence at or near the ESD site is uncommon through 5 years, particularly after R0 resection and in favorable histology. Distinguishing local recurrence from metachronous lesions is relevant to surveillance planning: the latter may accrue over time even when early post-resection failure is uncommon.
What to keep in mind
The review included 10 studies, and time-stratified data on metachronous lesions were limited.