Prospective Cohort Study demonstrates ESD as primary choice of treatment for neoplasia of over 2cmimprovements in QOL and survival rates anticipated with early treatments

August 5, 2022
National Cancer Center Japan
NTT Medical Center Tokyo
In Japanese

Highlights

• A prospective research with 1833 patients confirmed the effects of endoscopic submucosal dissection (ESD) treatments for early colorectal cancers and pre-cancerous lesions over 2cm, with low risk of metastasis and recurrence.
• Results demonstrate ESD outcomes, which maintains quality of life better post-treatments, may become the primary choice of treatments, compared to EMR, as the recurrence risk is low, and compared to surgical resection, the quality of life is much better
• Improvement is anticipated in quality of life and survival rates for colon cancer patients, a large population, with early treatments
• Colon cancer screening and follow-up checkup is recommended, as it will find tumors early bringing more benefits of early treatment

Summary

A team lead by the National Cancer Center Hospital conducted a prospective cohort study of 1883 patients, of tumors totaling 1965. They all had endoscopic submucosal dissection (ESD), a procedure that uses an endoscope to remove early stage colon cancers over 2cm with low risk of metastasis. Five year survival rates, disease specific survival rates, and intestine preservation rates were studied. 20 institutes took part in the study, demonstrating good results.

The results were published on Gastroenterology, one of the most authoritative academic journals for digestive organs, on July 7, 2022.

Endoscopic Mucosal Resection (EMR), which uses an electrical snare – a thin wire fed through the endoscope, to remove a tumor or lesion, is another method for treating early stage colon cancer over 2cm with low risk of metastasis. Surgery can ensure removing cancerous tissues, however, it tends to affect the post surgery quality of life of the patient. EMR takes little time, however, tumors over 2cm, larger than the snare diameter, need to be removed by piecemeal resections, at times leaving some tumor tissue unremoved, resulting in cancer recurrence. ESD requires a high level of expertise and longer timeframes, but is less invasive, and easier on the patient. Since made available through universal healthcare coverage in 2012 for colon cancers, it has proliferated, and research looking into its long-term safety and treatment effects was called for.

With this result, ESD may become the primary choice for tumors larger than 2cm as long as its risk of metastasis is rated low, as it can contain the much lower recurrence rate in comparison to EMR, and provide a better quality of life in comparison to surgery.

At the moment, EMR is the standard treatment in many countries overseas, as ESD requires a very high level of expertise; however, with these results ESD may be positioned as the standard treatment in many more countries, improving patient’s quality of life and survival rates with early stage diagnosis and treatment of colon cancer, with a very large patient population.

Publication

Journal

Gastroenterology

Title

Long-term Outcomes after Endoscopic Submucosal Dissection for Large Colorectal Epithelial Neoplasms: A Prospective, Multicenter, Cohort Trial from Japan

Authors

Ken Ohata, Nozomu Kobayashi, Eiji Sakai, Yoji Takeuchi, Akiko Chino, Hiroyuki Takamaru, Shinya Kodashima, Kinichi Hotta, Keita Harada, Hiroaki Ikematsu, Toshio Uraoka, Takashi Murakami, Shigetsugu Tsuji, Takashi Abe, Atsushi Katagiri, Shinichiro Hori, Tomoki Michida, Takuto Suzuki, Masakatsu Fukuzawa, Shinsuke Kiriyama, Kazutoshi Fukase, Yoshitaka Murakami, Hideki Ishikawa, Yutaka Saito (Corresponding author)

Publish Date

July 7, 2022

DOI

https://doi.org/10.1053/j.gastro.2022.07.002（linked to another site)