Long-term follow-up after endoscopic submucosal dissection of colorectal lesions in a Spanish cohort

Introduction: ESD in the colon is an increasingly important technique in Western countries. There are few studies that include long term follow-up. Aim: to analyze the long term recurrence free survival rate after ESD and to compare recurrence rates according to different variables. Methods: this was a prospective observational study of patients with a planned ESD from September 2008 to December 2015. When it was not possible to achieve an ESD, hybrid ESD was performed, either en bloc or piecemeal. Kaplan-Meier survival curves were used to assess the five year local recurrence free survival rate and the recurrence rate.The results were compared according to different factors. Results: of the 89 patients scheduled for ESD who were initially enrolled in the study, 69 were finally included for follow-up. ESD was performed in 31 (45 %) patients, KAR in eleven (16 %) and pKAR in 27 (39 %).The median follow-up was 27 months (range 6-60).The five year disease free survival rate was 81 %. The average number of endoscopies needed to eliminate recurrence was two (range 2-7) and no patient required surgery for this reason.The recurrence rate was significantly higher in piecemeal resections vs en bloc resections (27 % vs 15 %, p = 0.036) and R1 resections vs R0 resections (26 % vs degrees %, p = 0.034).The presence of affected or unknown lateral margins in en bloc resections without other poor prognosis factors had higher recurrence rates but the difference was not statistically significant (28 % vs 0 %, p = 0.09). Conclusions: in our study, the five year disease free survival rate was 81 % and no patient required surgery during follow-up. Piecemeal and R1 resections had significantly higher recurrence rates, as well as LM involvement, although this was not statistically significant.