Feasibility of endoscopic submucosal dissection for cecal tumors involving the ileocecal valve or appendiceal orifice.

Abstract

Endoscopic resection of the ileocecal valve lesions (ICVL) and peri-appendiceal orifice lesions (PAOL), is challenging. This study aimed to evaluate the feasibility of endoscopic submucosal dissection (ESD) for ICVLs and PAOLs compared with other cecal lesions (OCEL). This was a multicenter, retrospective cohort study conducted at a cancer center hospital and two community hospitals. Non-pedunculated cecal lesions that were intended to be treated by ESD followed by at least one surveillance colonoscopy were included. The main outcome was curative resection defined as en-bloc resection and R0 resection without risk factors of metastases. The secondary outcome was co lon preservation. A total of 206 patients with 206 cecal lesions, including 37 ICVL, 27 PAOL, and 142 OCEL, who were to be treated with ESD were included in this study. Curative resection rates were 75.7% for ICVL, 70.4% for PAOL, and 77.5% for OCEL (P=0.67). In the multivariate analysis of predictors of curative resection, tumor size (<40mm) (odds ratio [OR] 2.40; 95% confidence intervals [CI], 1.14-5.04; P=0.02) and a negative non-lifting sign (OR 6.12; 95% CI, 2.55-14.60; P<0.01) were significant. Colon preservation was achieved for 91.9% of the ICVL, 92.6% of the PAOL, and 90.8% of the OCEL (P=0.947). Based on curative resection and colon preservation rates, ESD was found to be feasible for ICVL and PAOL. Large tumor size (≥40mm) and positive non-lifting signs were significant factors for non-curative resection.