Shi WJ, Han JB, Cheng GM, Liu XC, Tao XW, Shan LQ. Pathological features and risk factors for submucosal infiltration of colorectal lateral spreading tumors. World J Gastrointest Surg 2025; 17(8): 107230 [DOI: 10.4240/wjgs.v17.i8.107230]
Corresponding Author of This Article
Liu-Qun Shan, MD, Department of General Surgery, The Second Hospital of Nanjing, No. 1-1 Zhongfu Road, Gulou District, Nanjing 210000, Jiangsu Province, China. shanliuqun721@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Wen-Jie Shi, Jian-Bo Han, Gong-Ming Cheng, Xu-Cheng Liu, Xue-Wen Tao, Liu-Qun Shan, Department of General Surgery, The Second Hospital of Nanjing, Nanjing 210000, Jiangsu Province, China
Author contributions: Shi WJ and Han JB contributed to study design, data collection, and manuscript preparation; Cheng GM assisted with endoscopic procedures and data acquisition; Liu XC provided statistical support; Tao XW contributed to pathological evaluation; Shan LQ supervised the study and revised the manuscript. All authors reviewed and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of The Second Hospital of Nanjing (approval number: 2022-LS-ky034). It was conducted in accordance with the principles of the Declaration of Helsinki and relevant national regulations.
Informed consent statement: This retrospective study used anonymized clinical data and did not involve any direct patient contact. The requirement for informed consent was waived by the Ethics Committee of The Second Hospital of Nanjing.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest related to this study.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Liu-Qun Shan, MD, Department of General Surgery, The Second Hospital of Nanjing, No. 1-1 Zhongfu Road, Gulou District, Nanjing 210000, Jiangsu Province, China. shanliuqun721@163.com
Received: April 25, 2025 Revised: June 3, 2025 Accepted: June 24, 2025 Published online: August 27, 2025 Processing time: 122 Days and 5.4 Hours
Abstract
BACKGROUND
To observe the endoscopic and pathological characteristics of laterally spreading tumors (LSTs) and explore the risk factors for carcinogenesis and submucosal infiltration.
AIM
To analyze the clinicopathological features of colorectal LSTs treated endoscopically and determine risk factors associated with carcinogenesis and submucosal invasion, providing evidence-based guidance for optimal treatment strategy selection.
METHODS
This study retrospectively analyzed the sex, age, and endoscopic and pathological features of patients who underwent endoscopic treatment for colorectal LSTs in our hospital from January 2021 to July 2024. Single-factor analysis was used to identify the risk factors for cancer and submucosal infiltration, and the factors with statistical significance were included in multivariate logistic regression analysis.
RESULTS
A total of 422 patients, including 224 males and 198 females, aged 63.45 ± 9.23 years, were included. There were 456 LST lesions in total. The length of the endoscopically resected specimens was 3.01 ± 0.48 cm, and the length of the lesions was 2.37 ± 1.59 cm. It was located in 115 rectums (25.2%), 40 sigmoid colon (8.8%), 26 descending colon (5.7%), 109 transverse colon (23.9%), 112 ascending colon (24.6%), and 54 ileocecal regions (11.8%). Endoscopic submucosal dissection (ESD) was performed in 237 patients (52.0%), and endoscopic mucosal resection (EMR) was performed in 95 patients (20.8%). There were 113 EMR with precutting cases (24.8%), 11 ESD with snare cases (2.4%), 4 delayed bleeding cases and 5 intraoperative perforations. The pathological results revealed 119 cases of low-grade intraepithelial neoplasia (26.1%), 221 cases of high-grade intraepithelial neoplasia (48.5%), 82 cases of intramucosal carcinoma (18.0%), and 34 cases of submucous invasive carcinoma (7.5%). Multiple logistic regression analyses revealed that lesion size ( > 2 cm), lesion location (rectal) and endoscopic classification [false depressed tubulovillous adenoma (LST-NG pseudodepressed type, LST-NG-PD), type 1 particles (LST-G homogenous type), and LST-G nodular mixed type], accompanied by large nodules (with) were independent risk factors for carcinogenesis; endoscopic classification (LST-NG-PD) and the presence of large nodules were independent risk factors for submucosal infiltration.
CONCLUSION
These risk factors provide practical guidance for treatment selection: LST-NG-PD with large nodules should prioritize ESD, while high-risk rectal lesions > 2 cm may require additional imaging evaluation before endoscopic resection.
Core Tip: This study investigates the endoscopic and pathological characteristics of laterally spreading tumors (LSTs) in the colon and rectum, focusing on the risk factors for carcinogenesis and submucosal infiltration. The results highlight that lesion size, location, and endoscopic classification, particularly the presence of large nodules, are independent risk factors for malignant transformation. Additionally, the endoscopic classification of LST-NG pseudodepressed type, along with large nodules, is a significant predictor of submucosal infiltration. The study emphasizes the importance of careful endoscopic evaluation for early detection and appropriate treatment strategies, including endoscopic submucosal dissection and mucosal resection.
