Endoscopic Submucosal Dissection for Early Colorectal Carcinoma with High-risk Criteria: Long-term Follow-up from the German Multicenter Registry.

Authors

Sara Moser, Andreas Probst, Alanna Ebigbo, Ingo Steinbrück, Hans-Peter Allgaier, Jürgen Pohl, Roland Reinehr, Viktor Rempel, Michael Anzinger, Franz Ludwig Dumoulin, Jörg Schirra, Dani Dakkak, Ulrike Denzer, Andreas Wannhoff, Stefan Sulk, Siegbert Faiss, Anna Muzalyova, Carola Fleischmann, Helmut Messmann

Published in

Endoscopy international open. Volume 14. Pages a29492685. Epub Sep 18, 2026.

Abstract

Background and Study Aim Endoscopic submucosal dissection (ESD) is recommended for selected colorectal lesions, especially those with superficial submucosal invasion, enabling en-bloc resection and accurate histopathologic assessment. However, the management of high-risk lesions following ESD, especially regarding additional surgery versus surveillance, remains debated. This study evaluated outcomes after ESD for pT1 colorectal carcinoma, comparing surgical versus conservative management. Patients/Materials and Methods This retrospective multicenter study included 92 patients with pT1 colorectal carcinoma treated by ESD at 14 German referral centers (January 2017-December 2020). Patients were classified as low-risk ( n = 34) or high-risk ( n = 58) based on histopathologic criteria. Long-term outcomes were compared between low- and high-risk patients, as well as between high-risk patients undergoing additional surgery versus conservative management. Results The overall three-year disease-free survival was 82.6%, without a significant difference between the low-risk (88.2%) and high-risk groups (79.3%; p = 0.276). Among high-risk patients, 56.9% received additional surgery and 43.1% were managed conservatively. Recurrences occurred exclusively in the high-risk group (5.2%). The R0 resection rate after ESD was higher in patients managed without additional surgery than in those who subsequently underwent surgery (76.0% vs. 45.5%; p = 0.019). Conclusion ESD is effective for curative management of selected early colorectal cancers (pT1), particularly in low-risk cases. In high-risk patients, surgery remains the standard, with no recurrences observed after additional surgery in our cohort. A substantial proportion of high-risk patients did not undergo surgery in clinical practice and showed a recurrence rate of 12% (3/25). These findings support current recommendations while reflecting real-world treatment patterns.

PMID:
42841101
Bibliographic data and abstract were imported from PubMed on 07 Oct 2026.

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