Emre Gorgun1, Cigdem Benlice2, Maher A Abbas1. 1Department of Colorectal Surgery, Cleveland Clinic, 2Department of General Surgery, Cleveland Clinic
Objective of the study: Need for colon-sparing intervention for premalignant lesion not amenable to conventional endoscopic excision has stimulated interest in advanced endoscopic techniques. The aim of this study was to report a single institution’s experience with these techniques.
Methods and procedures: A retrospective review was conducted of a prospectively collected database of all patients referred between 2011-2016 for colorectal resection of premalignant appearing and deemed endoscopically unresectable lesions by conventional endoscopic techniques. Patients were counseled about endoscopic submucosal dissection (ESD) with possible combined endoscopic-laparoscopic surgery (CELS) or alternatively colorectal resection (CR) if unable to resect endoscopically or suspicion for cancer. Lesion characteristic, resection rate, and complications were evaluated.
Results: 110 patients were analyzed [mean age 64 years, female gender 55 (50%), median body mass index 29.4 kg/m2]. Indications for interventions were large polyp (median endoscopic size 3 cm (range, 1.5-6.5) and/or difficult location [cecum (34.9%), ascending colon (22.7%), transverse colon (14.5%), hepatic flexure (11.8%), descending colon (6.3%), sigmoid colon (3.6%), rectum (3.6%), and splenic flexure (2.6%)]. Lesion morphology was sessile (N=98, 93%) and pedunculated (N=12, 7%). Successful endoscopic resection rate was 88.2% (N=97) [Figure]. Of these 97 cases, ESD was completed in 69 patients and 28 patients underwent CELS. Complication rate was 11.8% (13/110) [delayed bleeding (N=4), perforation (N=3), organ-space surgical site infection (SSI) (N=2), superficial SSI (N=1), and postoperative ileus (N=3)]. Out of 110 patients, 13 patients (11.8%) required colectomy for technical failure (7 patients) or carcinoma (6 patients). During median follow-up of 13 months (range 1-41 months), 2 patients had adenoma recurrence.
Conclusions: Advanced endoscopic surgery appears to be safe and effective alternative to colectomy for patients with complex premalignant lesions deemed unresectable with conventional endoscopic techniques.
Figure: Intraoperative and postoperative outcomes of 110 patients evaluated for advanced endoscopic resection
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79335
Program Number: S039
Presentation Session: Colorectal 1
Presentation Type: Podium
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