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Updated: Apr 17, 2026
The Pocket-Creation Procedure of Endoscopic Submucosal Dissection for Large Rectal Laterally Spreading Tumors
Published on: February 13, 2026
Clinicopathological factors of multiple lateral margin involvement after endoscopic submucosal dissection for early
Jun Hee Lee1, Jun Haeng Lee2, Kyoung-Mee Kim3
1Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
Background And Study Aims:
In some ESD specimens of EGC, tumors involve multiple lateral margins. However, the factors related to the number of lateral margins involved are unclear. We evaluated the factors related to the multiplicity of lateral margin involvement in specimens of ESD for EGC.
Patients And Methods:
The study included 1,358 patients treated with ESD for EGC between March 2004 and September 2011 at a single tertiary hospital. Of those, 71 patients (5.2%) were found to have lateral margin-positive specimens. The demographic, endoscopic, and pathological features between the single lateral margin-positive lesions (SLM+ group) and the multiple lateral margin-positive lesions (MLM+ group) were compared retrospectively.
Results:
Single lateral margin involvement was noted in 43 lesions (60.6%), and multiple lateral margin involvement was seen in 28 lesions (39.4%). Extremely well-differentiated adenocarcinoma (EWDA) and histological heterogeneity were more common in the MLM+ group (p = 0.043 and p = 0.070, respectively). In multivariate analysis, EWDA was the only significant risk factor for multiple lateral margin involvement (OR 4.453 [1.011-19.624, 95% CI], p = 0.048). Surgery was performed in 65% (46/71) of the patients as an additional treatment for positive lateral margin, while 20% (14/71) of the patients underwent an additional ESD. After additional treatment, residual tumors were observed in 65% (39/60) of the specimens. There was no local recurrence among the patients treated with either type of additional treatment.
Conclusions:
In ESD for EGC, multiple lateral margin involvement was related to the histological characteristics of the tumor, such as extremely well-differentiated adenocarcinoma and histological heterogeneity.
