Is endoscopic submucosal dissection safe in the management of early-stage colorectal cancers?

Background: Endoscopic submucosal dissection (ESD) is increasingly being adopted for the treatment of early- stage colorectal cancer (CRC) lesions. Methods: We retrospectively analyzed patients with early-stage CRC treated between 2015 and 2023, using ESD and colectomy databases, categorizing them into three groups: ESD only (n = 24), oncological colorectal resection (OCR) only (n = 90), and OCR after ESD (n = 59). We compared pathological and oncological outcomes among these groups. Results: The OCR after ESD group demonstrated higher non-granular lesions, and deeper submucosal invasion compared to ESD only group. The primary OCR group showed higher 2-year overall survival compared to ESDonly group (98.9 % vs 85.6 %, p = 0.01), with no colorectal cancer-related mortality in any of the groups. Notably, 2-year disease-free survival rates were comparable across all groups (93.8 % ESD only, 88.0 % primary OCR only, and 97.8 % for OCR after ESD, p = 0.27). Conclusion: The current study highlights feasibility the promising potential and oncologic safety of ESD in carefully selected patients with early malignant lesions.