COLORECTAL endoscopic submucosal dissection (ESD) was associated with very low rates of colorectal lesion recurrence at the original treatment site and excellent five-year patient survival, according to a prospective multicentre real-world cohort study conducted across 11 institutions in Hiroshima, Japan. The findings highlighted the effectiveness of colorectal ESD in clinical practice while emphasising the importance of continued surveillance following noncurative resection.
Study Evaluates Long-Term Colorectal ESD Outcomes
The prospective study investigated long-term local lesion recurrence and survival following colorectal ESD, addressing limited evidence regarding outcomes in real-world clinical settings.
Researchers included 1,732 patients with 1,838 colorectal lesions who underwent ESD between 2014 and 2018. The primary outcome was cumulative local recurrence, while secondary outcomes included factors associated with recurrence, overall survival, and cancer-specific survival.
Potential predictors of local recurrence were assessed using cause-specific Cox proportional hazards models with Firth’s penalised partial likelihood.
Recurrence Rates Remain Low Over Five Years
The cumulative local recurrence rates were 0.06% at one year, 0.64% at three years, and 0.75% at five years. The longest interval between ESD and documented recurrence was 52 months. Notably, no local recurrence was observed among patients who achieved curative resection.
Several factors were significantly associated with increased local recurrence risk. These included rectal lesion location (hazard ratio [HR]: 3.93; p=0.04), high-risk pathological features (HR: 14.3; p<0.001), R1 resection (HR: 7.59; p=0.003), and delayed bleeding (HR: 7.72; p=0.009).
Five-year overall survival reached 95.3%, while cancer-specific survival was 100%. However, among the 10 patients who experienced local recurrence, one developed liver and lung metastases and subsequently died 64 months after ESD.
Findings Highlight Importance of Continued Surveillance
The findings demonstrated that colorectal ESD was associated with favourable long-term outcomes and a particularly low risk of local colorectal lesion recurrence in real-world clinical practice. The absence of recurrence following curative resection further highlighted the importance of achieving complete lesion removal.
However, the occurrence of recurrence several years after treatment, alongside the reported metastatic progression and subsequent death in one patient, emphasised that recurrence cannot be entirely excluded.
The researchers concluded that long-term surveillance remains warranted following noncurative resection. These findings provide valuable real-world evidence to inform post-procedural monitoring and reinforce the importance of considering pathological risk factors and resection outcomes when planning follow-up after colorectal ESD.
Reference
Saino M et al. Long-term local recurrence and survival after colorectal endoscopic submucosal dissection: a prospective multicenter real-world cohort study. Endoscopy. 2026;58(11):1251-61.