Effects of colorectal endoscopic submucosal dissection on treatment for Tis carcinoma

Objective: From the viewpoint of surgery, this study examined the effects of colorectal endoscopic submucosal dissection (ESD) on treatment for Tis carcinoma over the past 10 years since the technique was adopted. Materials and methods: Among the 3,826 colorectal cancer patients treated at Juntendo University within the 20-year period between 1996 and 2015. The total number of colorectal ESD performed within the 10-year period after its adoption in 2006 was 734. Within the 20-year period, the 495 diagnosed with Tis carcinoma were classified into 2 groups: 216 and 279 treated before and after adoption of colorectal ESD in 2006, respectively. The effects of colorectal ESD on treatment for Tis carcinoma after adoption were examined by clinically comparing such carcinoma patients and methods to treat them. Results: The percentage of surgical procedures for Tis carcinoma decreased from 5.5 to 0.4% (p<0.01) after the adoption of colorectal ESD 10 years previously, while that of endoscopic procedures increased to 97.1%. The most frequent method to treat Tis carcinoma before adoption was snare polypectomy with endoscopic mucosal resection (EMR), at 141 (65.3%), followed by laparotomy, at 54 (25.0%), laparoscopic surgery, at 18 (8.3%), and transanal surgery, at 3 (1.4%). Among the latter, colorectal ESD was the most frequent method, at 154 (55.2%), while the number of polypectomy with EMR decreased to 117 (41.9%). The number of surgical procedures was 8 (2.9%). Conclusion: From the surgical viewpoint, the merit of colorectal ESD may be further reducing the invasiveness of treatment for Tis carcinoma by reducing the use of surgical procedures. Correspondence to: Yuichi Tomiki, Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan, Tel: +81-38133111; Fax: +81-38130731; E-mail: [email protected]