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LONG-TERM OUTCOMES OF HYBRID ENDOSCOPIC SUBMUCOSAL DISSECTION IN A TERTIARY CARE CENTER
Salih N. Karahan
*, Mustafa Oruc, Kamil Erozkan, Joshua Sommovilla, Scott Steele, Emre Gorgun
Colorectal Surgery, Cleveland Clinic, Cleveland, OH
Introduction: Hybrid Endoscopic Submucosal Dissection (H-ESD), which combines ESD and EMR, is increasingly used to overcome the technical challenges of standard ESD. It serves as an effective alternative for difficult colorectal ESD cases, offering a rescue treatment that helps avoid surgery and achieve complete resections when conventional ESD is not feasible. H-ESD has been shown to reduce operative time and complication rates compared to standard ESD. However, there is a lack of studies with large sample sizes and extended follow-up periods reporting on long-term outcomes and recurrence rates. This study aims to report the short- and long-term outcomes of H-ESD, including recurrence rates with extended follow-up.
Methods: Patients who underwent hybrid endoscopic submucosal dissection for colorectal neoplasms from November 2011 to December 2023 were retrospectively analyzed. The primary outcome was recurrence-free survival. Secondary outcomes included perioperative complications, en-bloc resection rate, R0 resection rate, and operative time. Cox regression analysis was performed to identify predictors of recurrence-free survival.
Results: Out of 1,446 patients who underwent endoluminal surgery during the study period, a total of 408 lesions from 391 patients were resected using H-ESD. The median patient age was 67 years [IQR: 59–73], and 191 (48.8%) were female. The median BMI was 28.29 kg/m2 [IQR: 24.84–32.69]. Most lesions (62.6%) were located in the right colon, with a median size of 30 mm [IQR: 20–40]. According to the Paris classification, most lesions were flat elevated (67.5%). The en-bloc resection rate was 28.9%, and the R0 resection rate was 78.4%. 14 (3.4%) patients required colon resection following histopathological examination. A total of 203 patients (49.8%) had follow-up colonoscopy, with a median follow-up of 24.8 months [IQR: 7.46–45.5]. The 3-year recurrence-free survival (RFS) was 87.2%. Increased age was an independent predictor of postoperative bleeding (OR: 1.07 [1.02–1.12]). R0 resection was associated with improved RFS (HR: 0.27 [0.11–0.66]), while older age (HR: 1.07 [1.01–1.13]) was associated with decreased RFS.
Conclusion: Hybrid endoscopic submucosal dissection is a safe and effective technique for managing colorectal neoplasms, with favorable long-term outcomes. R0 resection significantly improves recurrence-free survival, while increased age is associated with both higher rates of postoperative bleeding and decreased recurrence-free survival. Furthermore, the low rates of colon resection following H-ESD shows that it is an effective technique to prevent surgery.
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