Endoscopic full-thickness resection of colorectal lesions: results of the largest Portuguese cohort

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Aims To evaluate the efficacy and safety of EFTR for treating colorectal lesions in the biggest Portuguese registry. Methods Consecutive patients undergoing colorectal EFTR with a dedicated full-thickness resection device (FTRD) in our center were prospectively included. Primary outcomes were technical success (macroscopic complete en bloc resection), R0 and curative resection rates, procedure-associated adverse events, and recurrence rates. Secondary outcomes were baseline patient and procedure characteristics, including colorectal lesion type, size, location, and oncological outcomes. Results Between November 2020 and October 2023, 48 patients with colorectal lesions were referred to EFTR. Indications were primary resection of suspected T1 carcinoma (n=32, 66.7%); peri-diverticular/peri-appendiceal location (n=11, 23%, one of which was also a subepithelial lesion); recurrent adenomas (n=5, 10.4%). Patients were, on average, 68 years old (±11.3 years), and 75% (n=36) were men. Median lesion size was 14.8mm (±4,5 mm), most lesions were IIa or IIa+c (Paris Classification), and 41% (n=20) were proximal to the hepatic flexure. A hybrid EFTR with EMR (endoscopic mucosal resection) technique was used in 3 patients. Technical success was achieved in 44 procedures (91.7%), of which 38 (86.3%) were R0 resections. The lesion could not be reached or retracted into the cap in the remaining four. The average specimen size was 31mm (±6.9mm). Concerning histologically confirmed invasive adenocarcinoma (n=27), the curative resection rate was 41% (n=11). Of those with a non-curative resection (n=16), 11 patients (69%) underwent oncologic surgery, of which 6 (55%) had no residual cancer in the surgical specimen. The remaining patients were either deemed unfit for surgery (n=2) or are on the waiting list (n=3). During follow-up for local recurrence (n=11), two patients were subsequently referred for surgery after 6 and 18 months, respectively. The immediate perforation rate was 8.3% (n=4), three of which were due to kit malfunction, with one requiring surgery. Delayed hemorrhage was seen in 4,5% (n=2) of patients, and appendicitis occurred in one patient (11% of peri-appendiceal procedures). Conclusions Our results are overall in line with the largest international series. EFTR proved an effective and relatively safe en-bloc resection technique for complex colorectal lesions, reducing surgical overtreatment of benign and malignant lesions. Surgery would have led to overtreatment in 64% (n=28). Concerning invasive lesions, we achieved a curative rate of 41% and, interestingly, there was a high rate of surgical specimens without residual cancer (55%) on those with a non-curative resection, implying that there might be still room for further improvement on curative resection criteria. Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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