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Endoscopic full-thickness resection feasible, safe for early colorectal cancer
Using endoscopic full-thickness resection can help stratify patients with early colorectal cancer and allows patients with low-risk lesions to avoid surgery, according to research published in Gastrointestinal Endoscopy.
Arthur Schmidt, MD, of the department of medicine at the University of Freiburg in Germany, and colleagues wrote that differences in treatment recommendations for high-risk and low-risk lesions make classifying patients for the best treatment strategy critically important.
“However, low-risk versus high-risk lesions are difficult to discriminate before resection as criteria are based on histological features,” the researchers wrote. “Moreover, T1 cancer is often found incidentally after resection of non-suspicious polyps and further treatment after incomplete resection is not well defined.”
Researchers tested the emerging technique of endoscopic full-thickness resection (EFTR) in a retrospective study of 156 patients who underwent the procedure and had histological evidence of adenocarcinoma. They separated patients into two groups; patients who underwent EFTR after incomplete resection of a malignant polyp (n = 64), and patients with non-lifting lesions (n = 92).
Investigators found that the procedure achieved technical success in 144 of 156 patients (92.3%) with a mean procedural time of 42 minutes. The procedure also achieved microscopically complete resection in 112 patients (71.8%; 87.5% in group one and 60.9% in group two; P < .001).
The procedure was successful in discriminating between high-risk and low-risk lesions in 155 of 156 cases (99.3%). In group one, researchers identified that 84.1% of patients had low-risk lesions compared with 16.3% in group two.
Although further research is needed, Schmidt and colleagues wrote that that procedure demonstrated high technical efficacy and safety.
“As a primarily diagnostic procedure for tissue acquisition, it allows exact histological risk stratification in order to individually assign patients to the best treatment and avoid surgery for low-risk lesions,” they wrote. “For patients with high-risk lesions unfit for surgery, it might as well be a valuable option for local endoscopic treatment.” – by Alex Young
Disclosures: Healio Gastroenterology and Liver Disease could not confirm the authors’ relevant financial disclosures prior to publication.