Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2022; 14(7): 1337-1347
Published online Jul 15, 2022. doi: 10.4251/wjgo.v14.i7.1337
Predictors for malignant potential and deep submucosal invasion in colorectal laterally spreading tumors
Xiao-Wen Hao, Peng Li, Yong-Jun Wang, Ming Ji, Shu-Tian Zhang, Hai-Yun Shi
Xiao-Wen Hao, Peng Li, Yong-Jun Wang, Ming Ji, Shu-Tian Zhang, Hai-Yun Shi, National Clinical Research Centre for Digestive Disease, Beijing Digestive Disease Centre, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Shi HY designed the research study and performed the data collection; Hao XW analyzed the data and wrote the first draft of the manuscript; Li P, Wang YJ, Ji M and Zhang ST performed the endoscopic therapies; Shi HY reviewed and edited the manuscript; and all authors read and approved the final manuscript.
Supported by Beijing Nova Program, No. Z201100006820147; and Beijing Municipal Administration of Hospitals’ Youth Program, No. QML20180102.
Institutional review board statement: This study was approved by the Ethics Committee of Beijing Friendship Hospital (2020-P2-047-01) and was performed in accordance with the ethical guidelines of the 1975 Declaration of Helsinki.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hai-Yun Shi, MD, PhD, Associate Professor, National Clinical Research Centre for Digestive Disease, Beijing Digestive Disease Centre, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, Beijing 100050, China. shihaiyun1016@gmail.com
Received: March 15, 2022
Peer-review started: March 15, 2022
First decision: May 10, 2022
Revised: May 24, 2022
Accepted: June 22, 2022
Article in press: June 22, 2022
Published online: July 15, 2022
Abstract
BACKGROUND

Colorectal laterally spreading tumors (LSTs) with malignant potential require en bloc resection by endoscopic submucosal dissection (ESD), but lesions with deep submucosal invasion (SMI) are endoscopically unresectable.

AIM

To investigate the factors associated with high-grade dysplasia (HGD)/carcinoma and deep SMI in colorectal LSTs.

METHODS

The endoscopic and histological results of consecutive patients who underwent ESD for colorectal LSTs in our hospital from June 2013 to March 2019 were retrospectively analyzed. The characteristics of LST subtypes were compared. Risk factors for HGD/carcinoma and deep SMI (invasion depth ≥ 1000 μm) were determined using multivariate logistic regression.

RESULTS

A total of 323 patients with 341 colorectal LSTs were enrolled. Among the four subtypes, non-granular pseudodepressed (NG-PD) LSTs (85.5%) had the highest rate of HGD/carcinoma, followed by the granular nodular mixed (G-NM) (77.0%), granular homogenous (29.5%), and non-granular flat elevated (24.2%) subtypes. Deep SMI occurred commonly in NG-PD LSTs (12.9%). In the adjusted multivariate analysis, NG-PD [odds ratio (OR) = 16.8, P < 0.001) and G-NM (OR = 7.8, P < 0.001) subtypes, size ≥ 2 cm (OR = 2.2, P = 0.005), and positive non-lifting sign (OR = 3.3, P = 0.024) were independently associated with HGD/carcinoma. The NG-PD subtype (OR = 13.3, P < 0.001) and rectosigmoid location (OR = 8.7, P = 0.007) were independent risk factors for deep SMI.

CONCLUSION

Because of their increased risk for malignancy, it is highly recommended that NG-PD and G-NM LSTs are removed en bloc through ESD. Given their substantial risk for deep SMI, surgery needs to be considered for NG-PD LSTs located in the rectosigmoid, especially those with positive non-lifting signs.

Keywords: Colorectal laterally spreading tumors, Subtype, Deep submucosal invasion, Endoscopic submucosal dissection

Core Tip: The incidence of laterally spreading tumors (LSTs) is continually increasing; however, the optimal strategy for resecting large colorectal LSTs is still under debate. Endoscopic submucosal dissection (ESD) and surgery each have their pros and cons. In this work, we demonstrated that it is highly recommend that non-granular pseudodepressed (NG-PD) and granular nodular mixed LSTs are removed through ESD, and given their substantial risk for deep submucosal invasion, surgery needs to be considered in NG-PD LSTs located in the rectosigmoid, especially those with positive non-lifting signs.