Risk factors for incomplete resection and prolonged operative duration of endoscopic submucosal dissection for colorectal tumors

doi:10.3969/j.issn.1006-7795.2022.06.022

Abstract

Abstract: Objective To investigate risk factors for incomplete resection and prolonged operative duration of endoscopic submucosal dissection (ESD) for colorectal tumors. Methods Patients who received ESD procedures for colorectal tumors at Beijing Friendship Hospital, Capital Medical University between February 2014 and November 2021 were included in the study. The Chi-square test and logistic regression model were applied to analyze risk factors for incomplete resection and prolonged operative duration of ESD. Results A total of 433 patients were included in the final analysis. 98.8% of ESD procedures were completed successfully (428/433) and the mean operative time was (67.91±64.28) minutes. Incomplete resection rate was 20.56% (88/428), and risk factors for incomplete resection were tumor size over 4 cm (P=0.001,OR=3.017, 95%CI: 1.536-5.924), severe submucosal fibrosis(P<0.001, OR=5.825, 95%CI: 2.540-13.355)and the non-lifting sign(P=0.025,OR=2.831,95%CI:1.141-7.025). 15.7% of patients (67/428) underwent prolonged ESD which last more than 120 minutes. Female (P=0.044,OR=1.832,95%CI: 1.017-3.300), tumor size over 4cm (P<0.001,OR=10.276,95%CI: 5.340-19.774)were significantly associated with prolonged operative duration. Conclusion Risk factors for incomplete resection included tumor size larger than 4cm, tumor with ulcerative colitis, severe submucosal fibrosis, and the non-lifting sign. Risk factors for prolonged operative time included female patients and larger tumor size.

Key words: colonoscopy, endoscopic submucosal dissection, complete resection, prolonged operation duration, risk factors

CLC Number:

Gu Feng, Jiang Wei, Liu Yuhang, Zhai Huihong. Risk factors for incomplete resection and prolonged operative duration of endoscopic submucosal dissection for colorectal tumors[J]. Journal of Capital Medical University, 2022, 43(6): 959-965.

0
/ / Recommend

Add to citation manager EndNote|Reference Manager|ProCite|BibTeX|RefWorks

URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2022.06.022

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2022/V43/I6/959

References

[1] Sung H, Ferlay J, Siegel R L, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209－249.
[2] US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation stateme[J]. JAMA, 2021. 325(19): 1965－1977.
[3] Hashiguchi Y, Muro K, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer[J]. Int J Clin Oncol, 2020, 25(1): 1－42.
[4] Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline[J]. Endoscopy, 2015, 47(9): 829－854.
[5] 中华医学会消化内镜学分会, 中国抗癌协会肿瘤内镜学专业委员会. 中国早期结直肠癌筛查及内镜诊治指南(2014,北京)[J]. 中华医学杂志, 2015, 95(28): 2235－2252.
[6] Isomoto H, Shikuwa S, Yamaguchi N, et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study[J]. Gut, 2009, 58(3): 331－336.
[7] Tanaka S, Oka S, Kaneko I, et al. Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization[J]. Gastrointest Endosc, 2007, 66(1): 100－107.
[8] Tanaka S, Terasaki M, Kanao H, et al. Current status and future perspectives of endoscopic submucosal dissection for colorectal tumors[J]. Dig Endosc, 2012, 24 Suppl 1: 73－79.
[9] Kim E S, Cho K B, Park K S, et al. Factors predictive of perforation during endoscopic submucosal dissection for the treatment of colorectal tumors[J]. Endoscopy, 2011, 43(7): 573－578.
[10] Terasaki M, Tanaka S, Shigita K, et al. Risk factors for delayed bleeding after endoscopic submucosal dissection for colorectal neoplasms[J]. Int J Colorectal Dis, 2014, 29(7): 877－882.
[11] 王锡山. 从中美结直肠癌流行病学特征看结直肠癌早诊早治的重要性[J]. 中华结直肠疾病电子杂志, 2021, 10(1): 26－33.
[12] Imai K, Hotta K, Yamaguchi Y, et al. Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training[J]. Gastrointest Endosc, 2016, 83(5): 954－962.
[13] Hurlstone D P, Atkinson R, Sanders D S, et al. Achieving R0 resection in the colorectum using endoscopic submucosal dissection[J]. Br J Surg, 2007, 94(12): 1536－1542.
[14] Agapov M, Dvoinikova E. Factors predicting clinical outcomes of endoscopic submucosal dissection in the rectum and sigmoid colon during the learning curve[J]. Endosc Int Open, 2014, 2(4): E235-E240.
[15] Fukuchi T, Hirasawa K, Sato C, et al. Factors influencing interruption of colorectal endoscopic submucosal dissection[J]. Surg Endosc, 2021, 35(10): 5497－5507.
[16] Hayashi N, Tanaka S, Nishiyama S, et al. Predictors of incomplete resection and perforation associated with endoscopic submucosal dissection for colorectal tumors[J]. Gastrointest Endosc, 2014, 79(3): 427－435.
[17] Hori K, Uraoka T, Harada K, et al. Predictive factors for technically difficult endoscopic submucosal dissection in the colorectum[J]. Endoscopy, 2014, 46(10): 862－870.
[18] Iacopini F, Saito Y, Bella A, et al. Colorectal endoscopic submucosal dissection: predictors and neoplasm-related gradients of difficulty[J]. Endosc Int Open, 2017, 5(9): E839-E846.
[19] Isomoto H, Nishiyama H, Yamaguchi N, et al. Clinicopathological factors associated with clinical outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms[J]. Endoscopy, 2009, 41(8): 679－683.
[20] Lee S P, Kim J H, Sung I K, et al. Effect of submucosal fibrosis on endoscopic submucosal dissection of colorectal tumors: pathologic review of 173 cases[J]. J Gastroenterol Hepatol, 2015, 30(5): 872－878.
[21] Matsumoto A, Tanaka S, Oba S, et al. Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis[J]. Scand J Gastroenterol, 2010, 45(11): 1329－1337.
[22] Matsumoto S, Uehara T, Mashima H. Construction of a preoperative scoring system to predict the difficulty level of colorectal endoscopic submucosal dissection[J]. PLoS One, 2019, 14(6): e0219096.
[23] Sato K, Ito S, Kitagawa T, et al. Factors affecting the technical difficulty and clinical outcome of endoscopic submucosal dissection for colorectal tumors[J]. Surg Endosc, 2014, 28(10): 2959－2965.
[24] Seo M, Yang D H, Kim J, et al. Clinical outcomes of colorectal endoscopic submucosal dissection and risk factors associated with piecemeal resection[J]. Turk J Gastroenterol, 2018, 29(4): 473－480.
[25] Takeuchi Y, Iishi H, Tanaka S, et al. Factors associated with technical difficulties and adverse events of colorectal endoscopic submucosal dissection: retrospective exploratory factor analysis of a multicenter prospective cohort[J]. Int J Colorectal Dis, 2014, 29(10): 1275－1284.
[26] Tamai N, Saito Y, Sakamoto T, et al. Safety and efficacy of colorectal endoscopic submucosal dissection in elders: clinical and follow-up outcomes[J]. Int J Colorectal Dis, 2012, 27(11): 1493－1499.
[27] Xu X, Wang T, Zheng Z Q, et al. Endoscopic submucosal dissection for large colorectal epithelial neoplasms: a single center experience in north China[J]. Medicine (Baltimore), 2017, 96(36): e7967.
[28] Boda K, Oka S, Tanaka S, et al. Clinical outcomes of endoscopic submucosal dissection for colorectal tumors: a large multicenter retrospective study from the Hiroshima GI Endoscopy Research Group[J]. Gastrointest Endosc, 2018, 87(3): 714－722.