Study on the long-term clinical efficacy of endoscopic submucosal dissection in colorectal mucosal lesions
Objective To evaluate the long-term clinical efficacy of endoscopic submucosal dissection(ESD)in the treatment of early colorectal cancer and precancerous lesions,and to explore the risk factors of local recurrence after operation.Methods From January 1,2011 to December 31,2022,the clinical and endoscopic follow-up data of 1 095 patients(1 186 lesions)who underwent ESD at Peking University Third Hospital and were pathologically diagnosed as early colorectal cancer or precancerous lesions after ESD were retrospectively analyzed.The long-term efficacy of ESD was evaluated,which included 5-year overall survival rate,disease-specific survival rate,local recurrence rate,and recurrence-free survival rate.The Kaplan-Meier method was used for survival analysis.Multivariate Cox proportional hazards regression models were performed to analyze local recurrence related clinical pathological factors.Results After ESD,1 067 patients were followed up,and the median follow-up period was 44.4(20.3,62.1)months.There were 734 patients having endoscopic follow-up(798 lesions,the follow-up rate was 67.0％).During the follow-up period,26 patients died,and the 5-year overall survival rate and disease-specific survival rate were 96.0％and 100.0％,respectively.During the follow-up period,local recurrence was observed in 17 lesions,with a recurrence rate of 2.1％(17/798)and a median time of recurrence after ESD was 11.8(4.9,21.4)months.The 5-year cumulative recurrence rate was 3.4％,and the 5-year recurrence-free survival rate was 94.0％.The results of multivariate Cox regression analysis showed that lesions located in the rectum(HR=2.64,95％confidence interval(95％CI)1.00 to 6.94,P=0.049),histologically incomplete resection(HR=4.40,95％CI 1.62 to 11.94,P=0.004),and positive vertical margin(HR=10.27,95％CI 2.95 to 35.77,P＜0.001)were independent risk factors for local recurrence after ESD in the treatment of colorectal mucosal lesions.Conclusions Long-term efficacy of ESD in the treatment of colorectal mucosal lesions are favorable.Lesions located in the rectum,histologically incomplete resection,and positive vertical margin are independent risk factors for local recurrence after ESD in the treatment of colorectal mucosal lesions.
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