Endoscopic submucosal dissection for early colon cancer. Early results

AIM: to identify risk factors for perforation during colorectal ESD for early colon cancer.
PATIENTS AND METHODS: the study included 61 patients with early colon cancer who underwent ESD in 2018–2023. Perforation was defined as a deep muscular layer defect down to serosa with its preservation without connection with free peritoneal cavity. Clinical risk factors for perforation during ESD, including age, gender, tumor morphology, tumor size, tumor location, procedure time, were analyzed.
RESULTS: the mean ESD specimen size was 20.0 (1.50–2.80) mm. The overall en bloc resection rate was 81.7%. Perforations occurred during ESD in 6 of 61 patients (9.9%). All perforations were successfully treated with endoscopic closure using hemoclips and nonsurgical management. No emergency surgery occurred. On univariate analysis, tumor size ≥ 2.0 cm (p = 0.04), localization in the right colon (p = 0.04), 2B-high type\JNET classification (p = 0.0004), negative lifting (p = 0.04) were the factors most significantly associated with perforation.
CONCLUSION: tumor size ≥ 2.0 cm, tumor site in the right colon, 2B-high type (JNET), negative lifting are risk factors for perforation during ESD in early colon cancer.

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