Keijiro Kawasaki

Local recurrence after rectal endoscopic submucosal dissection: a case of tumor cell implantation

We report a case of local recurrence of cancer after rectal endoscopic submucosal dissection (ESD). A 52-year-old male underwent a curative resection with ESD for rectal intramucosal cancer. Seventy-four months after ESD, surveillance colonoscopy showed an elevated lesion on the ESD scar, suspicious of a recurrence. The patient subsequently underwent a low anterior resection (intersphincteric) with lymph node dissection. Pathology revealed a well-differentiated adenocarcinoma, similar to the ESD specimen. We suspected that the local recurrence was caused by implantation of tumor cells during the ESD, due to surgical manipulation performed with the tumor in an exposed setting for a long period of time.

Laparoscopic surgery after endoscopic resection for rectal cancer and neuroendocrine tumors

BackgroundEndoscopic resection (ER) of tumors causes inflammation, edema, fibrosis, and adhesions in the surrounding tissue. However, little is known about the effect of ER on subsequent laparoscopic surgery for rectal tumors. The objective of this retrospective study was to analyze the effect of ER on subsequent laparoscopic surgery for rectal tumors.MethodsTwenty-eight patients underwent laparoscopic surgery for rectal adenocarcinoma with submucosal invasion or a rectal neuroendocrine tumor at our hospital between January 2005 and December 2012. A group of 14 patients who underwent laparoscopic surgery with previous ER was compared to a group of 14 patients who underwent laparoscopic surgery without previous ER.ResultsThough most fibrosis involved the submucosa after polypectomy and endoscopic mucosal resection, fibrosis after endoscopic submucosal dissection involved the muscularis propria in two patients, and the subserosa in one patient. There were no statistically significant differences in clinical outcomes between the groups.ConclusionLaparoscopic surgery after ER for rectal tumors is safe and feasible. Laparoscopic surgery is the reasonable first-choice for radical treatment of rectal tumors after ER.