Endoscopic submucosal dissection for colorectal lateral spreading tumors larger than 10 cm: Is it feasible?

Background: Colorectal endoscopic submucosal dissection (ESD) was applied to lesions, such as giant colorectal lateral spreading tumors (LSTs) > 10 cm, by an expert ESD endoscopist despite several limitations, such as a relatively high perforation rate and high technical difficulty. Objective: To investigate the feasibility and safety of ESD for giant colorectal LSTs >= 10 cm. Design: Retrospective study. Setting: Tertiary-care center. Patients: A total of 163 patients underwent colorectal ESD between 2009 and 2014 by a single expert ESD endoscopist at Gangnam Severance Hospital, Seoul, Korea. Among them, 9 patients had giant colorectal LSTs >= 10 cm. Interventions: Review of records. Main Outcome Measurements: Clinicopathologic factors and oncologic outcome associated with ESD between giant colorectal LSTs and others. Results: Colorectal LSTs >= 10 cm were classified as giant colorectal LSTs. Nine giant colorectal LST lesions were localized to the following regions: descending colon (n = 1), sigmoid colon (n = 1), and rectum (n = 7). The average maximal diameter of giant colorectal LSTs was 120.8 mm, and the procedure time was 270.0 minutes. Two lesions were of the whole nodular type, and 7 were focal nodular lesions. The en bloc and curative resection rates for ESD for giant colorectal LSTs were 88.9% and 100%, respectively. The adverse event rate was 44.4%. No strictures, local recurrences, or distant metastases occurred over a mean follow-up period of 27.1 months. Limitations: Retrospective, single-center study. Conclusions: ESD of giant colorectal LSTs appears to be a feasible and curative treatment, even though it is associated with a higher adverse event rate, higher degree of technical difficulty, and longer procedure time.