Efficacy And Safety Of Endoscopic Submucosal Dissection Of Colorectal Lesions In The Elderly

Aim:To present the efficacy and safety of endoscopic submucosal dissection of colorectal lesions in the elderly,analyse the influence factors.Methods:249 cases of colorectal ESD carried out in our center between May 2011 and December 2016 were analyzed,effectiveness of dissection,complications and tumor recurrence were investigated.Results:69.2%of the patients with advanced colorectal cancer had warning symptom s,and 76.5%were the elderly.86.96%of the 69 submucosal leasions were locat ed in the rectum.Of the 180 mucosal lesions,45.56%were located in the rectu m,while 21.11%in the sigmoid colon and 19.44%in the ascending colon.The majority of the elderly had the pathological type of LIEN and HIEN,while LIE N and neuroendocrine neoplasm were most common in the non-elderly.The aver age size of the removed tumors in the submucosal layer was 0.87±0.49 cm,and the average size of the removed tumors in the mucosal layer was 2.89±1.52cm.There were no significance difference in the pathological type between the elder ly and non-elderly.In the elderly,the success rate of the ESD procedure was 97.0%,slightly higher than non-elderly(96.6%);87.2%of the lesions were en-block resection,less than non-elderly(91.5%);72.9%of the lesions were R0 resection,less than non-elderly(80.2%);while 67.7%were curative resection,less than no n-elderly(72.4%).Complications happened in 6.0%of the elderly,equal with the non-elderly.The average time of hospital stays after ESD procedures were 5.38±2.41 days;the elderly stays more days in hospital after ESD procedures than th e non-elderly.The diameter of the lesion and age were relevant factors of compl ication and piecemeal resection.14.1%(22/156)of the mucosal lesions had posit ive lateral and(or)basal margin,while 17.9%(12/67)of the submucosal lesions had positive lateral and(or)basal margin.The recurrence rate after ESD was 0.0%?0.1%?Conclusions:The results confirm that ESD is an effective and safe modality for treatment of colorectal epithelial neoplasia and non-epithelial neoplasia in the colon and r ectum.The larger leasions and older age leads to higher incidence of complicati on and piecemeal resection.