Local recurrence after endoscopic resection for large colorectal neoplasia: A multicenter prospective study in Japan

Shiro Oka, Shinji Tanaka, Yutaka Saito, Hiroyasu Iishi, Shin Ei Kudo, Hiroaki Ikematsu, Masahiro Igarashi, Yusuke Saitoh, Yuji Inoue, Kiyonori Kobayashi, Takashi Hisabe, Osamu Tsuruta, Yasushi Sano, Hiroo Yamano, Seiji Shimizu, Naohisa Yahagi, Toshiaki Watanabe, Hisashi Nakamura, Takahiro Fujii, Hideki IshikawaKenichi Sugihara

Research output: Contribution to journalArticlepeer-review

195 Citations (Scopus)


OBJECTIVES:Conventional endoscopic resection (CER) is a widely accepted treatment for early colorectal neoplasia; however, large colorectal neoplasias remain problematic, as they necessitate piecemeal resection, increasing the risk of local recurrence. Endoscopic submucosal dissection (ESD) can improve the en bloc resection rate. This study aimed to evaluate local recurrence and its associated risk factors after endoscopic resection (ER) for colorectal neoplasias ≥20 mm.METHODS:A multicenter prospective study at 18 medium-and high-volume specialized institutions was conducted in Japan. Follow-up colonoscopy was performed after 12 months in cases of complete resection and after 3-6 months in cases of incomplete resection. Local recurrence was confirmed by endoscopic findings and/or pathological analysis.RESULTS:Follow-up colonoscopy was performed in 1,524 of 1,845 enrolled colorectal neoplasias (mean age, 65 years; 885 men; median tumor size, 32.8 mm). The local recurrence rates were 4.3% (65/1,524), 6.8% (55/808), and 1.4% (10/716) for the entire cohort, for CER, and for ESD, respectively. The relative risks of local recurrence were 0.21 (95% confidence interval, 0.11-0.39) with ESD compared with CER, 0.32 (95% confidence interval, 0.11-0.92) with en bloc ESD compared with en bloc CER, and 0.90 (95% confidence interval, 0.39-2.12) with piecemeal ESD compared with piecemeal CER. Significant factors associated with local recurrence were piecemeal resection, laterally spreading tumors of granular type, tumor size ≥40 mm, no pre-treatment magnification, and ≤10 years of experience in CER, and piecemeal resection only in ESD.CONCLUSIONS:En bloc ESD reduces the local recurrence rate for large colorectal neoplasias. Piecemeal resection is the most important risk factor for local recurrence regardless of the ER method used.

Original languageEnglish
Pages (from-to)697-707
Number of pages11
JournalAmerican Journal of Gastroenterology
Issue number5
Publication statusPublished - 2015 May 8

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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