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The Pocket-Creation Procedure of Endoscopic Submucosal Dissection for Large Rectal Laterally Spreading Tumors
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Long-Term Outcomes After Endoscopic Submucosal Dissection for T1 Colorectal Cancer: A Multicenter Prospective Study.

Takuro Hamada1, Toshio Kuwai2, Yuki Kamigaichi1

  • 1Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan.

Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
|March 20, 2026
PubMed
Summary
This summary is machine-generated.

Endoscopic submucosal dissection (ESD) is effective for low-risk T1 colorectal cancer (CRC). For high-risk T1 CRC, surgery after ESD reduces local recurrence but doesn't significantly impact distant metastasis or disease-specific survival.

Keywords:
Colorectal CancerEndoscopic Submucosal DissectionLong-Term OutcomeRecurrenceT1 Colorectal Cancer

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Area of Science:

  • Gastroenterology
  • Oncology
  • Surgical Endoscopy

Background:

  • Long-term data on endoscopic submucosal dissection (ESD) for T1 colorectal cancer (CRC) are limited.
  • Risk stratification is crucial for determining optimal management strategies.

Purpose of the Study:

  • To evaluate the long-term efficacy of ESD for T1 CRC.
  • To assess the impact of additional surgery on outcomes in high-risk T1 CRC patients.

Main Methods:

  • A prospective, multicenter cohort study of 383 patients with T1 CRC undergoing ESD.
  • Patients were stratified into low- and high-risk groups based on JSCCR guidelines.
  • High-risk patients were managed with either additional surgery or follow-up alone.

Main Results:

  • No recurrence or disease-specific mortality was observed in the low-risk group.
  • In the high-risk group, additional surgery significantly reduced 5-year local recurrence rates (0% vs. 6.8%) compared to follow-up alone.
  • Overall survival was better in the surgery group (95.2%) than the follow-up group (79.7%), but 5-year disease-specific survival was similar (98.5% vs. 98.4%).

Conclusions:

  • ESD is a suitable treatment for low-risk T1 CRC, potentially obviating the need for intensive surveillance.
  • For high-risk T1 CRC, additional surgery can prevent local recurrence, though its benefit on distant metastasis and long-term survival requires further investigation.