Mo1670 EFFICACY AND SAFETY OF ESTD AND ESD IN THE TREATMENT OF LARGE AREA RECTAL LATERALLY SPREADING TUMORS

Abstract

This study aims to compare the efficacy and safety of endoscopic submucosal tunnel dissection (ESTD) and endoscopic submucosal dissection (ESD) in the treatment of large area rectal laterally spreading tumors (LST). The clinical data, operation procedures and pathology of rectal LST treated with ESD and ESTD from August 2011 to February 2019 in the Center of Digestive Endoscopy, West China Hospital of Sichuan University were retrospectively analyzed. The rates of en bloc, curative resection, complications and recurrence of tumors were compared and analyzed, then we evaluated the safety and effectiveness of ESD and ESTD in the treatment of large area LSTs. There were 122 patients with rectal LST in ESD and ESTD groups. The lesion area was 12.6±14.1 cm2, 24.5±19.9 cm2, respectively, p < 0.001.;the en bloc resection rate was 88.3% ,97.8%,respectively,p=0.066; the dissection speed was 23.3±18.3 mm2/min, 27.1±13.2 mm2/min, respectively, p=0.239; the curative resection rate was 98.7%, 86.7%, respectively,p=0.006; There were 7 cases of non-curative resection in the two groups after operation, of which 6 cases underwent additional surgery. Postoperative complications were mainly fever and hematochezia without endoscopic intervention, with fewer serious complications. The overall canceration rate of LST was 17.3%. The follow-up time of the two groups was 16.4 ±16.0 months and 23.20±16.3 months, respectively. Only one case recurred in ESD group. In the analysis of large area lesions(>3cm), there were 90 patients with large area LST, 50 patients in ESD group and 40 patients in ESTD group .The lesion areas of the two groups was 17.4±15.5 cm2 , 26.0±19.8cm2, respectively, p=0.025;the en bloc resection rate was 85%, 97.5%, respectively, p=0.034; the dissection speed was 28.4±20.3 mm2/min, 28.3 ±12.9 mm2/min, respectively, p=0.991; the curative resection rate was 92.5%, 100%, respectively, p=0.084. Both ESD and ESTD can safely and effectively resect rectal LST, which was not affected by the size of lesions. There was no significant difference in the dissection speed and the curative resection rate. When large area LST was resected, the rate of en bloc resection of ESTD was higher than that of ESD.View Large Image Figure ViewerDownload Hi-res image Download (PPT)