Original articleAlimentary tractCost Analysis of Endoscopic Mucosal Resection vs Surgery for Large Laterally Spreading Colorectal Lesions
Section snippets
Study Design, Setting, and Patients
Consecutive patients referred to 1 of 7 Australian academic hospitals for the management of large LSL ≥20 mm were enrolled in this prospective observational study. The term laterally spreading tumor has traditionally been used to describe these lesions; however, using “tumor” as a descriptor implies the universal presence of submucosal invasion. This is misleading so we have avoided the use of this term. All lesions had been initially identified and referred by a nationally accredited
Patient and Lesion Characteristics
Between January 2010 and December 2013 EMR was performed on 1489 lesions in 1353 patients (mean age, 67 years; 52.1% male). American Society of Anaesthesiology scores were 1, 2, 3, and 4 in 642 (47.5%), 540 (39.9%), 158 (11.7%), and 5 (0.4%) patients, respectively. Mean lesion size was 37.3 mm (median, 30 mm; range, 20–180 mm; standard deviation [SD], 17.1 mm). A previous attempt at resection by the referring endoscopist had occurred in 167 patients (12.3%). EMR with complete lesion excision
Discussion
Over the last decade, EMR has evolved into a safe, efficacious, predominantly day-stay technique for the management of large LSL. Despite this many and in some countries most patients are still being managed surgically.11 Large LSL are often found in elderly comorbid patients where surgical mortality may be up to 10%.12 We have previously shown by modelling using well-validated surgical risk algorithms that EMR for large LSL is safer than surgery. The number needed to treat by EMR to prevent 1
Acknowledgments
The authors thank Nimalan Pathmanathan, MBBS, FRACS, Colorectal Surgeon at Westmead Hospital, Sydney, New South Wales, for reviewing the surgical outcome estimates.
References (19)
- et al.
Colorectal cancer
Lancet
(2014) - et al.
Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia
Gastroenterology
(2011) - et al.
Long-term outcome following surgery for colorectal cancers in octogenarians: a single institution’s experience of 204 patients
J Gastrointest Surg
(2012) - et al.
Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer
Gastroenterology
(2006) - et al.
Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial
Lancet
(2005) - et al.
Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon
Gastrointest Endosc
(2014) - et al.
Treatment patterns and costs associated with sessile colorectal polyps
Am J Gastroenterol
(2002) - et al.
Work and resources needed for endoscopic resection of large sessile colorectal polyps
Clin Gastroenterol Hepatol
(2007) - et al.
Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths
N Engl J Med
(2012)
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Conflicts of interest The authors disclose no conflicts.
Funding Dr Mahesh Jayanna is supported by a grant from the National Health and Medical Research Council of Australia. The Cancer Institute of New South Wales provided funding for a research nurse and data manager to assist with the administration of the study. There was no influence from the National Health and Medical Research Council or the Cancer Institute on study design or conduct, data collection and management, analysis, interpretation, preparation and review, or approval of the manuscript.
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Authors share co-first authorship.