| Theme | Treatment of early rectal cancer -- Local excision vs. endoscopic resection | |
|---|---|---|
| Title | Usefulness of endoscopic submucosal dissection for rectal lesions : an alternative technique to transanal resection | |
| Publish Date | 2007/07 | |
| Author | Yumi Mashimo | Division of Endoscopy, National Cancer Center Hospital / Department of Internal Medicine, Chofu Tozan Hospital |
| Author | Yutaka Saito | Division of Endoscopy, National Cancer Center Hospital |
| Author | Toshio Uraoka | Division of Endoscopy, National Cancer Center Hospital / Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences / Okayama University Hospital |
| Author | Takahisa Matsuda | Division of Endoscopy, National Cancer Center Hospital |
| [ Summary ] | ESD was used to treat rectal lesions which could not be adequately treated with conventional EMR, to decrease local recurrence rates. Results after treatment with ESD and TAR were compared. Regarding local recurrence, there have been no cases in the ESD group (median follow-up period, 14 months). In contrast, local recurrence has been 6 out of 19 lesions (32 %) in the TAR group (median follow-up period, 43.5 months). Regarding early and late complications, there were 2 types of complications related to ESD. Rectal perforations occurred in 2 patients out of 33 (6 %) and minor post-procedure bleeding occurred in 1 patient (3 %). However, all 3 cases were successfully managed conservatively with no blood transfusions or additional procedures necessary. In comparison, there were 2 types of complications with TAR [2 cases (10 %) of post-procedure minor bleeding]. In conclusion, results demonstrated that ESD seems more effective for decreasing local recurrence rates compared to TAR. There was a small, but significant number of complications associated with ESD procedures. ESD techniques are difficult to manage and available at a limited number of institutions. The best management technique is to select procedures in accordance with the character of the lesions and patients overall condition, considering the benefits or problems with ESD and TAR. |
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