Presentation Information
[SY8-10]Efficacy and Safety of Collaborative Endoscopic and Surgical Treatment for Challenging Colorectal Neoplasms
*Hidehito Maeda1, Fumisato Sasaki1, Kenji Baba2 (1. Department of Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan, 2. Department of Digestive Surgery, Kagoshima University Graduate School of Medical and Dental Sciences)
Background:
Colorectal ESD is widely used, but severe adhesions, fibrosis, or unfavorable location can make ESD alone difficult. We have used collaborative endoscopic and surgical treatment for such challenging colorectal neoplasms.
Aim:
To evaluate the efficacy and safety of this approach.
Methods:
We retrospectively reviewed 11 patients with 12 colorectal lesions treated between October 2016 and April 2026. Clinical features, procedures, histology, and adverse events were analyzed.
Results:
The mean age was 71.8 years; 8 patients were male. Lesions were located in the cecum (n=1), ascending colon (n=2), transverse colon (n=2), sigmoid colon (n=3), and rectum (n=4). Macroscopic types were protruded (n=6), superficially elevated (n=5), and depressed (n=1). Seven lesions with severe adhesions underwent laparoscopic adhesiolysis plus ESD; 5 were resected endoscopically, whereas 2 with suspected muscularis propria invasion underwent surgical resection on the same day. Four protruded rectal or anal canal lesions underwent transanal minimally invasive surgery plus ESD, and all were resected. One severely fibrotic lesion at a postoperative anastomosis, initially considered for full-thickness resection, was resected by ESD alone. Histology of the 10 endoscopically resected lesions showed adenoma in 3, intramucosal carcinoma in 2, SM1 carcinoma in 3, and SM2 carcinoma in 2. Postoperative bleeding occurred in 1 patient, but no perforation, anastomotic leakage, or other severe adverse events occurred.
Conclusions:
Collaborative endoscopic and surgical treatment may be a useful and safe minimally invasive option for selected challenging colorectal neoplasms.
Colorectal ESD is widely used, but severe adhesions, fibrosis, or unfavorable location can make ESD alone difficult. We have used collaborative endoscopic and surgical treatment for such challenging colorectal neoplasms.
Aim:
To evaluate the efficacy and safety of this approach.
Methods:
We retrospectively reviewed 11 patients with 12 colorectal lesions treated between October 2016 and April 2026. Clinical features, procedures, histology, and adverse events were analyzed.
Results:
The mean age was 71.8 years; 8 patients were male. Lesions were located in the cecum (n=1), ascending colon (n=2), transverse colon (n=2), sigmoid colon (n=3), and rectum (n=4). Macroscopic types were protruded (n=6), superficially elevated (n=5), and depressed (n=1). Seven lesions with severe adhesions underwent laparoscopic adhesiolysis plus ESD; 5 were resected endoscopically, whereas 2 with suspected muscularis propria invasion underwent surgical resection on the same day. Four protruded rectal or anal canal lesions underwent transanal minimally invasive surgery plus ESD, and all were resected. One severely fibrotic lesion at a postoperative anastomosis, initially considered for full-thickness resection, was resected by ESD alone. Histology of the 10 endoscopically resected lesions showed adenoma in 3, intramucosal carcinoma in 2, SM1 carcinoma in 3, and SM2 carcinoma in 2. Postoperative bleeding occurred in 1 patient, but no perforation, anastomotic leakage, or other severe adverse events occurred.
Conclusions:
Collaborative endoscopic and surgical treatment may be a useful and safe minimally invasive option for selected challenging colorectal neoplasms.