TY - JOUR
T1 - Optimal surveillance interval after piecemeal endoscopic mucosal resection for large colorectal neoplasia
T2 - a multicenter randomized controlled trial
AU - Nakajima, Takeshi
AU - Sakamoto, Taku
AU - Hori, Shinichiro
AU - Yamada, Shinya
AU - Ikematsu, Hiroaki
AU - Harada, Keita
AU - Chiu, Han Mo
AU - Kiriyama, Shinsuke
AU - Michida, Tomoki
AU - Hotta, Kinichi
AU - Sakamoto, Naoto
AU - Abe, Takashi
AU - Chino, Akiko
AU - Fukuzawa, Masakatsu
AU - Kobayashi, Nozomu
AU - Fukase, Kazutoshi
AU - Matsuda, Takahisa
AU - Murakami, Yoshitaka
AU - Ishikawa, Hideki
AU - Saito, Yutaka
N1 - Funding Information:
This work was supported by The National Cancer Center Research and Development Fund (21-25, 29-A-13). The funder had no role in designing the study, handling the data, or in the preparation and publication of the manuscript.
Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.
PY - 2021
Y1 - 2021
N2 - Background and aims: Colorectal neoplastic lesions (≥ 20 mm) are commonly treated via piecemeal endoscopic mucosal resection (p-EMR) but have a high rate of local recurrence. We aimed to clarify the optimal surveillance interval after p-EMR for these neoplasias. Methods: In this multicenter (15 participating institutions) prospective, randomized trial, 180 patients recruited over a 4-year period and were classified based on tumor location, tumor diameter, histological diagnosis, institution, and number of resected specimens. The patients underwent curative p-EMR followed by scheduled surveillance colonoscopy at 3, 6, 12, and 24 months after p-EMR (group A; n = 90) or at 6, 12, and 24 months after p-EMR (group B; n = 90). The primary endpoint was cumulative local recurrence at 6 months after p-EMR. Secondary endpoints included local recurrence and the cumulative surgical resection rate of recurrent tumors during the 24-month follow-up period. Results: The median tumor diameter was 25 mm (IQR 20–30). Six months after p-EMR, 12 and 6 local recurrences were noted in groups A and B, which corresponded to 13 and 8 recurrences, respectively, during the 24-month surveillance period. The primary and secondary endpoints of recurrence were not significantly different between the groups on either intention-to-treat or per-protocol analysis; no surgery case was observed in group B when a strict surveillance protocol of 6-, 12-, and 24-month follow-up post-EMR was followed. Conclusions: For patients who underwent p-EMR for neoplastic lesions, additional postprocedural 3-month surveillance did not show superior results in detecting recurrence compared with a 6-month surveillance interval. Clinical trial registration: UMIN000015740.
AB - Background and aims: Colorectal neoplastic lesions (≥ 20 mm) are commonly treated via piecemeal endoscopic mucosal resection (p-EMR) but have a high rate of local recurrence. We aimed to clarify the optimal surveillance interval after p-EMR for these neoplasias. Methods: In this multicenter (15 participating institutions) prospective, randomized trial, 180 patients recruited over a 4-year period and were classified based on tumor location, tumor diameter, histological diagnosis, institution, and number of resected specimens. The patients underwent curative p-EMR followed by scheduled surveillance colonoscopy at 3, 6, 12, and 24 months after p-EMR (group A; n = 90) or at 6, 12, and 24 months after p-EMR (group B; n = 90). The primary endpoint was cumulative local recurrence at 6 months after p-EMR. Secondary endpoints included local recurrence and the cumulative surgical resection rate of recurrent tumors during the 24-month follow-up period. Results: The median tumor diameter was 25 mm (IQR 20–30). Six months after p-EMR, 12 and 6 local recurrences were noted in groups A and B, which corresponded to 13 and 8 recurrences, respectively, during the 24-month surveillance period. The primary and secondary endpoints of recurrence were not significantly different between the groups on either intention-to-treat or per-protocol analysis; no surgery case was observed in group B when a strict surveillance protocol of 6-, 12-, and 24-month follow-up post-EMR was followed. Conclusions: For patients who underwent p-EMR for neoplastic lesions, additional postprocedural 3-month surveillance did not show superior results in detecting recurrence compared with a 6-month surveillance interval. Clinical trial registration: UMIN000015740.
KW - Colorectal neoplasia
KW - Local recurrence
KW - Piecemeal endoscopic mucosal resection (p-EMR)
KW - Surveillance colonoscopy
KW - Surveillance interval
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U2 - 10.1007/s00464-021-08311-6
DO - 10.1007/s00464-021-08311-6
M3 - Article
C2 - 33569725
AN - SCOPUS:85100839162
JO - Surgical Endoscopy
JF - Surgical Endoscopy
SN - 0930-2794
ER -