Concerns of en bloc resection on long-term outcomes after EMR for colorectal laterally spreading tumor

AbstractGlomus tumors are mesenchymal tumors that arise from glomus bodies and most frequently occur in the distal extremities. These tumors can occur throughout the body and are typically benign. However, a very small fraction of glomus tumors displays aggressive features and are considered atypical or malignant. We report on our experience and management of the first case in the literature of a malignant glomus tumor in a child originating in the paraspinal region with involvement of the cervical spine. Malignant glomus tumors tend to be locally aggressive, and en bloc resection is difficult, especially when the tumors occur in the head and neck. Additional studies on disease progression and adjuvant treatment outcomes are necessary to determine the best treatment approach and long-term outcomes in patients with malignant glomus tumors.

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Long-term Outcomes Following En Bloc Resection for Sacral Tumor: A Retrospective Analysis of 93 Cases

Orthopedics ◽

10.3928/01477447-20110627-18 ◽

2011 ◽

Cited By ~ 1

Author(s):

Zhi-yu Zhang ◽

Chang-feng Fu ◽

Ying-xin Yang ◽

Li-qiang Wang ◽

Yan Cui ◽

...

Keyword(s):

Retrospective Analysis ◽

En Bloc Resection ◽

Bloc Resection ◽

Long Term Outcomes ◽

En Bloc ◽

Sacral Tumor

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Impact of en bloc resection on long-term outcomes after endoscopic mucosal resection: a matched cohort study

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2019.12.025 ◽

2020 ◽

Vol 91 (5) ◽

pp. 1155-1163.e1 ◽

Cited By ~ 2

Author(s):

David J. Tate ◽

Mayenaaz Sidhu ◽

Iddo Bar-Yishay ◽

Lobke Desomer ◽

Gregor Brown ◽

...

Keyword(s):

Cohort Study ◽

Endoscopic Mucosal Resection ◽

En Bloc Resection ◽

Bloc Resection ◽

Matched Cohort ◽

Long Term Outcomes ◽

En Bloc ◽

Matched Cohort Study ◽

Mucosal Resection

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Long-term outcomes following en bloc resection for pancreatic ductal adenocarcinoma of the head with portomesenteric venous invasion

Asian Journal of Surgery ◽

10.1016/j.asjsur.2020.07.021 ◽

2021 ◽

Vol 44 (1) ◽

pp. 313-320

Author(s):

Sunjong Han ◽

Dong Wook Choi ◽

Seong Ho Choi ◽

Jin Seok Heo ◽

In Woong Han ◽

...

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Venous Invasion ◽

En Bloc Resection ◽

Bloc Resection ◽

Ductal Adenocarcinoma ◽

Long Term Outcomes ◽

En Bloc

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Endoscopic Resection of Ampullary Tumours: Long-term Outcomes and Adverse Events

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz007 ◽

2019 ◽

Vol 3 (1) ◽

pp. 17-25

Author(s):

Ali Alali ◽

Alberto Espino ◽

Maria Moris ◽

Myriam Martel ◽

Ingrid Schwartz ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Resection ◽

En Bloc Resection ◽

Bloc Resection ◽

Low Grade ◽

Long Term Outcomes ◽

En Bloc ◽

Tertiary Center

Abstract Background The management of ampullary lesions has shifted from surgical approach to endoscopic resection. Previous reports were limited by small numbers of patients and short follow-up. The aim of this study is to describe short- and long-term outcomes in a large cohort of patients undergoing endoscopic ampullectomy. Methods Retrospective study of endoscopic ampullectomies performed at a tertiary center from January 1999 to October 2016. Information recorded includes patient demographics, clinical outcomes, lesion pathology, procedural events, adverse events and follow-up data. Results Overall, 103 patients underwent endoscopic resection of ampullary tumours (mean age 62.3 ± 14.3 years, 50.5% female, mean lesion size 20.9 mm; 94.9% adenomas, with a majority of lesions exhibiting low-grade dysplasia (72.7%). Complete endoscopic resection was achieved in 82.5% at initial procedure. Final complete endoscopic resection was achieved in all patients with benign pathology on follow-up procedures. Final pathology showed that 11% had previously undiagnosed invasive carcinoma. Delayed postprocedure bleeding occurred in 21.4%, all of which were managed successfully at endoscopy. Acute pancreatitis complicated 15.5% of procedures (mild in 93.8%). Perforation occurred in 5.8%, all treated conservatively except for one patient requiring surgery. Piecemeal resection was associated with significantly higher recurrence compared to en-bloc resection (54.3% versus 26.2%, respectively, P = 0.012). All recurrences were treated endoscopically. Conclusion Endoscopic ampullectomy appears both safe and effective in managing patients with ampullary tumours in experienced hands. Most adverse events can be managed conservatively. Many patients develop recurrence during long-term follow-up but can be managed endoscopically. Recurrence rates may be reduced by performing initial en-bloc resection.

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Long-term follow-up after colorectal endoscopic submucosal dissection in 182 cases

Endoscopy International Open ◽

10.1055/a-1321-1271 ◽

2021 ◽

Vol 09 (02) ◽

pp. E258-E262

Author(s):

Christian Suchy ◽

Moritz Berger ◽

Ingo Steinbrück ◽

Tsuneo Oyama ◽

Naohisa Yahagi ◽

...

Keyword(s):

Case Series ◽

En Bloc Resection ◽

Bloc Resection ◽

Published Data ◽

Low Grade ◽

Recurrence Rates ◽

En Bloc ◽

Long Term Follow Up

Abstract Background and study aims We previously reported a case series of our first 182 colorectal endoscopic submucosal dissections (ESDs). In the initial series, 155 ESDs had been technically feasible, with 137 en bloc resections and 97 en bloc resections with free margins (R0). Here, we present long-term follow-up data, with particular emphasis on cases where either en bloc resection was not achieved or en bloc resection resulted in positive margins (R1). Patients and methods Between September 2012 and October 2015, we performed 182 consecutive ESD procedures in 178 patients (median size 41.0 ± 17.4 mm; localization rectum vs. proximal rectum 63 vs. 119). Data on follow-up were obtained from our endoscopy database and from referring physicians. Results Of the initial cohort, 11 patients underwent surgery; follow-up data were available for 141 of the remaining 171 cases (82,5 %) with a median follow-up of 2.43 years (range 0.15–6.53). Recurrent adenoma was observed in 8 patients (n = 2 after margin positive en bloc ESD; n = 6 after fragmented resection). Recurrence rates were lower after en bloc resection, irrespective of involved margins (1.8 vs. 18,2 %; P < 0.01). All recurrences were low-grade adenomas and could be managed endoscopically. Conclusions The rate of recurrence is low after en bloc ESD, in particular if a one-piece resection can be achieved. Recurrence after fragmented resection is comparable to published data on piecemeal mucosal resection.

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Long-Term Outcomes of High-Dose Single-Fraction Radiosurgery for Chordomas of the Spine and Sacrum

Neurosurgery ◽

10.1093/neuros/nyz310_177 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Jenny Jin ◽

John Berry-Candelabra ◽

Y Josh Yamada ◽

Daniel Higginson ◽

Adam Schmitt ◽

...

Keyword(s):

Local Recurrence ◽

En Bloc Resection ◽

Bloc Resection ◽

High Dose ◽

En Bloc ◽

Intralesional Resection ◽

Single Fraction ◽

Mobile Spine ◽

Symptom Response

Abstract INTRODUCTION To evaluate outcomes of patients with primary chordomas treated with spine stereotactic radiosurgery (SRS) alone or in combination with surgery, drawing from a single-institution database to elucidate treatment options associated with durable radiographic control of these conventionally radioresistant tumors. Chordomas result in significant morbidity, with a high rate of local recurrence and potential for metastases. SRS as a primary treatment could save patients from extensive surgery. Spine SRS outcomes support exploration of its role in the durable control of these conventionally radioresistant tumors. METHODS Clinical records were reviewed for outcomes of patients with primary chordoma of the mobile spine and sacrum who underwent single-fraction SRS between 2006 and 2017. Radiographic local recurrence-free survival (LRFS), overall survival (OS), symptom response, and toxicity were assessed in relation to extent of surgery. RESULTS In total, 35 patients with de novo chordoma of the mobile spine (49%) and sacrum (51%) received SRS with a median post-SRS follow-up of 38.8 mo (range: 2.0-122.9). The median PTV dose was 24Gy (range: 18–24Gy). Overall, 12 patients (33%) underwent definitive SRS and 23 patients (66%) underwent surgery followed by adjuvant SRS. Surgical strategies included separation surgery prior to SRS, curettage/intralesional resection, and en bloc resection in 7, 6, and 10 patients, respectively. The 3- and 5-yr LRFS rates were 86.2% and 80.5% respectively. Among 32 patients receiving 24 Gy (91%), the 3- and 5-yr LRFS were 96.3% and 89.9%. The 3- and 5-yr OS rates were 90.0% and 84.3%. The symptom response rate to treatment was 88% for pain and radiculopathy. Extent or type of surgery was not associated with LRFS, OS, or symptom response rates (P > .05), but en bloc resection was associated with higher CTCAE v. 5.0 surgical toxicity compared to epidural decompression and curettage/intralesional resection (P = .03). The long-term = grade 2 SRS toxicity rate was 31%, including 17% grade 3 tissue necrosis, recurrent laryngeal nerve palsy, fracture, and secondary malignancy. CONCLUSION High-dose spine SRS offers the chance of durable radiographic control and effective symptom relief with acceptable toxicity for primary chordomas as either definitive or adjuvant therapy.

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Endoscopic submucosal dissection of early colorectal neoplasms with a monopolar scissor-type knife: short- to long-term outcomes

Endoscopy ◽

10.1055/s-0043-113631 ◽

2017 ◽

Vol 49 (09) ◽

pp. 913-918 ◽

Cited By ~ 14

Author(s):

Toshio Kuwai ◽

Toshiki Yamaguchi ◽

Hiroki Imagawa ◽

Yuki Sumida ◽

Takeshi Takasago ◽

...

Keyword(s):

Survival Rate ◽

Endoscopic Submucosal Dissection ◽

Colorectal Neoplasms ◽

En Bloc Resection ◽

Long Term Outcomes ◽

En Bloc ◽

Delayed Bleeding ◽

Submucosal Dissection ◽

Short And Long Term

Abstract Background and study aims Endoscopic submucosal dissection (ESD) for colorectal neoplasms remains challenging because of technical issues imposed by the complex anatomical features of the large intestine. We evaluated the feasibility, and the short- and long-term clinical outcomes of ESD for early colorectal neoplasms performed using the Stag-beetle Knife Jr. (SB Knife Jr.) Patients and methods We retrospectively assessed 228 patients who underwent ESD for 247 colorectal lesions with the SB Knife Jr. Clinicopathological characteristics of the neoplasms, complications, and various short- and long-term outcomes were evaluated. Results Mean tumor size was 34.3 mm and median procedure time was 76 minutes. The SB Knife Jr. achieved 98.4 % en bloc resection, 93.9 % complete resection, and 85.4 % curative resection. No perforations occurred during the procedure, and a delayed bleeding rate of 2.4 % was observed. Long-term outcomes were favorable with no distant recurrence, 1.1 % local recurrence, a 5-year overall survival rate of 94.1 % and 5-year tumor-specific survival rate of 98.6 % in patients with cancer. Conclusions ESD using the SB Knife Jr. is technically efficient and safe in treating early colorectal neoplasms and is associated with favorable short- and long-term outcomes.

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Therapeutic strategy involving endoscopic resection for cN0 superficial carcinoma of the esophagus.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.1 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 1-1

Author(s):

T. Iizuka ◽

D. Kikuchi ◽

S. Hoteya

Keyword(s):

Endoscopic Resection ◽

En Bloc Resection ◽

Bloc Resection ◽

Additional Treatment ◽

En Bloc ◽

Carcinoma Of The Esophagus ◽

Secondary Hemorrhage ◽

Long Term Follow Up

1 Background: With the progress in endoscopic submucosal dissection (ESD) which enables en bloc resection irrespective of the size of lesion, a therapeutic strategy has become feasible whereby ESD is undertaken first, followed by considering additional treatment based on the results of histologic exploration. In this study, we attempted to clarify the clinical results in patients who had undergone additional treatment after endoscopic resection (ER) for cN0 superficial carcinoma. Methods: Of 140 patients diagnosed as having T1a-MM-SM2 lesions of squamous cell carcinoma of the esophagus who had undergone ER between January 1998 and March 2010, 83 patients who received additional treatment after ER (surgery, 27 pts; chemoradiotherapy [CRT], 56 pts.) were the subjects of this study. The mean duration of observation was 45.1 months. Results: The en bloc resection rate was 86%. There were 5 patients (6%) who had complications associated with ER, including perforation in 2 patients, secondary hemorrhage in a patient and pneumonia in 2 patients. Complications associated with additional treatment were noted in 13 patients (15.6%), including secondary hemorrhage, recurrent laryngeal nerve paralysis and pulmonary infarction in one patient each, pneumonia in 3, grade ≥ 3 myelosuppression in 5, and syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and radiation pneumonitis in one patient each. Long-term follow-up revealed no local recurrence and no patients who experienced late toxicity due to CRT. The tumor recurred in 4 patients, the site of recurrent lesion being the mediastinum in 3 patients and the cervical lymph node in one patient, of whom 2 patients died of the primary disease. The 5-year survival rate was 88.4%. Conclusions: Endoscopic resection plus additional treatment for superficial carcinoma of the esophagus did not entail the development of any serious complications; thus, such combined treatment was safe and feasible. The long-term follow-up results were fairly gratifying, and ER with subsequent additional treatment is considered to be valid for patients with cN0 superficial carcinoma of the esophagus. No significant financial relationships to disclose.

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