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
Processing time: 119 Days and 16 Hours
ARTICLE HIGHLIGHTS
Research background

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) is associated with a high en bloc resection rate, low risk of recurrence and perfect pathological analysis. However, the possibility of a positive postoperative pathological resection margin exists, which would require additional surgical procedures. Surgery has a high complication rate, high mortality and prolonged hospital stays.

Research motivation

Accurate preoperative assessment based on various risk factors to identify carcinoma and invasion depth is essential for selecting an appropriate therapeutic strategy.

Research objectives

This study aimed to identify the predictors of carcinoma, invasion depth and endoscopically unresectable lesions for colorectal LSTs and to facilitate appropriate preoperative selection.

Research methods

This retrospective study analysed the endoscopic and histological results of consecutive patients who underwent ESD for colorectal LSTs in our hospital during a six-year period. The characteristics of the LSTs were compared by subtypes. Risk factors for high-grade dysplasia (HGD)/carcinoma and deep submucosal invasion (SMI) (invasion depth ≥ 1000 μm) were determined for each morphologic subtype.

Research results

Among the four subtypes, non-granular pseudodepressed (NG-PD) LSTs had the highest rate of HGD/carcinoma and deep SMI (invasion depth ≥ 1000 μm). NG-PD subtype and rectosigmoid location were the independent risk factors for deep SMI in adjusted multivariate analysis.

Research conclusions

We demonstrated that it is highly recommend that NG-PD and granular nodular mixed (G-NM) LSTs are removed through ESD; given their substantial risk for deep SMI, surgery needs to be considered in NG-PD LSTs located in the rectosigmoid, especially those with positive non-lifting signs.

Research perspectives

A risk score chart, which can determine the risk for carcinoma, invasion depth and endoscopically unresectable lesions for colorectal LSTs should be developed. It can help endoscopists in selective use of different types of endo-resection or to proceed to surgery instead of endoscopy.