Endoscopic submucosal dissection versus local excision for early rectal neoplasms: a comparative study.

Area of Science:

• Gastroenterology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Transanal local excision (LE) is a standard treatment for early rectal neoplasms.
• Endoscopic submucosal dissection (ESD) is a newer technique for en bloc resection of large rectal neoplasms.
• No direct comparison between ESD and LE for early rectal neoplasms exists.

Purpose of the Study:

• To compare the short-term clinical outcomes of endoscopic submucosal dissection (ESD) versus transanal local excision (LE) for early rectal neoplasms.
• To evaluate differences in recovery and morbidity between the two procedures.

Main Methods:

• A retrospective comparison of 14 patients undergoing ESD (2007-2010) with 30 matched patients undergoing LE (2000-2009).
• Focus on early rectal neoplasms not amenable to conventional endoscopic resection.
• Comparison of postprocedure recovery and morbidity metrics.

Main Results:

• Lesion size was similar, but lesions were located higher in the ESD group (mean 8.6 cm vs 5.0 cm).
• En bloc resection rates were 85.7% for ESD and 100% for LE.
• ESD showed a trend towards longer operative time (77.5 vs 50.0 min) but significantly lower morbidity (7.1% vs 33.3%) and faster ambulation (0 vs 1 day).
• Hospital stay was comparable (2.5 vs 4.0 days).

Conclusions:

• Endoscopic submucosal dissection (ESD) demonstrates superior short-term outcomes, including faster recovery and potentially reduced morbidity, compared to transanal local excision (LE) for early rectal neoplasms.
• These findings suggest ESD may be a beneficial alternative for specific rectal neoplasm cases.
• Larger prospective studies are recommended to validate these preliminary results and further establish the benefits of rectal ESD.