Risk factors for local recurrence and appropriate surveillance interval after endoscopic resection

Figure 1 Pathological characteristics of primary and recurrent colorectal tumors. Most of the recurrent lesions were low grade adenoma.

Figure 2 Endoscopic submucosal dissection was attempted for a lateral spreading tumor-granular measuring 60 mm and was located in the ascending colon. A: However, the surgery was converted to a piecemeal resection and argon plasma coagulation was performed at the end of the procedure. The tumor histology was tubulovillous adenoma and the horizontal margin was unclear; B: After 3 mo, colonoscopy revealed a recurrent lesion and thus additional endoscopic mucosal resection was performed. Surprisingly, the histological analysis revealed mixed adeno-endocrine carcinoma T1b with indistinct margins. Thereafter, additional surgery was performed. The final depth was T3 (sub-serosal). APC: Argon plasma coagulation; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; MANEC: Mixed adeno-endocrine carcinoma; LST-G: Laterally spreading tumor granular type.

Figure 3 An 82-year-old woman underwent Endoscopic submucosal dissection for a sessile polyp that measured 20 mm in diameter and was located in the ascending colon. A: The tumor histology was T1b cancer with an indistinct margin; however, the patient refused surgical operation because of her old age; B: After 3 mo, colonoscopy revealed a recurrent lesion and surgery was performed. ESD: Endoscopic submucosal dissection.

Figure 4 Accumulated recurrence free rate sub-analysis to identify the types of techniques. EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection.