Article révisé par les pairs
Résumé : Background and study aims: Endoscopic submucosal dissection (ESD) in colorectal lesions is technically demanding, and a significant rate of non-curative procedures is expected. We aimed to assess the rate of residual lesion after a non-curative ESD for colorectal cancer (CRC), and to establish predictive scores to be applied in the clinical setting. Patients and Methods: Retrospective multicenter analysis of consecutive colorectal ESDs. Patients with non-curative ESDs performed for the treatment of CRC lesions submitted to complementary surgery or with at least one follow-up endoscopy were included. Results: From 2255 colorectal ESDs, 381 (17%) were non-curative, and 135 of them were performed in CRC lesions. Residual lesion was observed in 24 (18%) patients. Surgery was performed in 96 patients, and 76 (79%) had no residual lesion in the colorectal wall or in the lymph nodes. Residual lesion rate for SM1 cancers was 0%, and for >SM1 cancers was also 0% if no other risk factors were present. Independent risk factors for lymph node metastasis were poor differentiation and lymphatic permeation (NC-Lymph score). Risk factors for the presence of residual lesion in the wall was piecemeal resection, poor differentiation and positive or indeterminate vertical margin (NC-Wall score). Conclusions: Lymphatic permeation or poor differentiation warrants surgery due to the high risk of lymph node metastasis, mainly in >SM1 cancers. In the remaining cases, en-bloc and R0 resections determine low risk of residual lesion in the wall. Our scores can be a useful tool for the management of patients submitted to non-curative colorectal ESDs.

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