Endoscopic submuxosal dissection versus laparoscopic resection for early colorectal neoplasms: a case-control sutdy

Abstract

BACKGROUND: The standard treatment for large colorectal neoplasms that are not amenable to complete endoscopic removal is laparoscopic resection. Endoscopic submucosal dissection (ESD) has been recently introduced as a novel procedure that enables en bloc resection of large colorectal neoplasms. To date, no report can be found in the literature comparing ESD and laparoscopic resection for treating early colorectal neoplasms. OBJECTIVE: To compare the short-term clinical outcomes of ESD versus laparoscopic resection for early colorectal neoplasms that are not amenable to en bloc endoscopic resection with conventional techniques. METHODS: Between January 2006 and June 2009, 31 patients diagnosed with early colorectal neoplasms (≧2 cm in size and without endoscopic signs of massive submucosal invasion) that were deemed not feasible for en bloc endoscopic resection with conventional techniques underwent 33 ESDs. They were compared with a historical cohort (control group) of 28 patients with early colorectal neoplasms who underwent laparoscopic resection. Controls were matched for age, sex, and characteristics of the neoplasms, including site, size, and pathology. Short-term clinical outcomes including post-procedure recovery and morbidity were compared between the two groups. RESULTS: ESD was successfully accomplished in 29 out of the 33 procedures (87.9%). In the ESD group, the mean size of the neoplasms was 2.2±0.18 cm, and the mean procedure time was 96 min (range, 40-108 min). En bloc resection was achieved in 27 ESD procedures (81.8%). Perforation occurred in 3 out of the 29 accomplished ESD procedures (10.3%), and all were successfully managed with endoscopic clipping. The laparoscopic group had a short-term morbidity rate of 35.7%. One patient developed anastomotic leak after laparoscopic resection and required reoperation. Comparing with the laparoscopic group, the ESD group had significantly lower morbidity, earlier post-procedure recovery, and shorter hospital stay (Table 1).