Perforation During Endoscopic Submucosal Dissection for Early Colon Cancer: Are Oncological Outcomes Impacted?

Abstract

Introduction: Endoscopic submucosal dissection (ESD) is accepted in the treatment of early colorectal carcinoma with low pathological risk features for lymph node metastasis. ESD provides higher en-bloc resection and lower recurrence rates but is associated with higher perforation rates. Given the limited data available about the impact of intraprocedural perforation during ESD on the oncological outcomes, this study aims to assess the short and long-term oncological outcomes of ESD on malignant colorectal lesions Methods: Retrospectively, patients who underwent ESD in a tertiary care center from Jan 2011 to Dec 2021 and had cancer in the final pathology were included. Patients were divided into 3 groups: 1) patients who successfully underwent ESD followed by survivorship; 2) patients who underwent organ resection during or after ESD either because perforation occurred during the procedure, or the lesion was deemed to be invasive; 3) patients who underwent organ resection within 2-8 weeks of ESD based on pathology results. Primary outcome was cancer recurrence. Results: Sixty-eight of 906 patients (7.5%) who underwent ESD had invasive carcinoma. 63 patients were included in the analysis. There were 12, 10 and 41 patients in the first, second and third groups, respectively. Intergroup demographics were similar. En-bloc and R0 resection rates were 83% in the first group. Mean follow up duration was 21.2 months. Cancer recurrence was not observed. Conclusion: ESD can be safely performed in carefully selected early colorectal cancers. Intraprocedural perforation during ESD does not negatively impact oncological outcomes. Larger series with long-term follow-up are warranted.