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Ng HI, Chen BH, Zhang YM, Zhang W, Liu Y, Wang GQ. Clinical application of endoscopic submucosal dissection for superficially invasive squamous cell carcinoma/high-grade squamous intraepithelial lesion involving the canal anal. Tech Coloproctol 2024; 28:90. [PMID: 39085740 DOI: 10.1007/s10151-024-02966-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/22/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Superficially invasive squamous cell carcinoma (SISCC) and high-grade squamous intraepithelial lesions (HSIL) involving the anal canal are rare, and their surgical management involves local excision. Endoscopic submucosal dissection (ESD) has recently emerged as a promising treatment. This study aimed to evaluate the feasibility and safety of ESD for SISCC and HSIL in the anal canal. METHODS All patients diagnosed with SISCC or HSIL in the anal canal who underwent ESD between November 2018 and May 2023 were included. Patient age, sex, pathology, human immunodeficiency virus (HIV) status, human papillomavirus (HPV) status, T stage, en bloc rate, and R0 resection rate were analyzed. RESULTS Ten patients, including two men and eight women, with a median age of 61 (51-68) years were enrolled. All patients were HIV-negative, but five (50%) were HPV-positive. Pathological examination showed tumor stage of two patients as T2, one as T0 of SISCC, and seven as Tis of HSIL. The median specimen and tumor sizes were 24 (6-65) mm and 18 (6-55) mm, respectively. The en bloc and R0 resection rates were 100% and 80%, respectively. No severe complications occurred and no recurrence was observed at the follow-up (median follow-up period, 9 (1-35) months). CONCLUSIONS ESD is a reliable and minimally invasive procedure that enables more individualized treatment options for specific groups. As we were limited by the length of the observation period, the long-term performance of ESD for SISCC and HSIL involving the anal canal requires further investigation.
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Affiliation(s)
- H-I Ng
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - B-H Chen
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Y-M Zhang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - W Zhang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Y Liu
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - G-Q Wang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Li H, Sun X, Yang L, Xu R, Li P. Case report: a precancerous lesion associated with HPV in the anal canal diagnosed by magnifying endoscopy with narrow-band imaging and resected by endoscopic submucosal dissection. Front Med (Lausanne) 2023; 10:1103182. [PMID: 37181349 PMCID: PMC10169570 DOI: 10.3389/fmed.2023.1103182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Although anal cancer remains rarely diagnosed in the world, its frequency is rising, especially in high-risk groups. The prognosis of advanced anal cancer is poor. However, there are still few reports on the endoscopic diagnosis and treatment of early anal cancer and its precancerous lesions. A 60-year-old woman was referred to our hospital for endoscopic treatment of a flat precancerous lesion in the anal canal, which was identified by narrow-band imaging (NBI) and confirmed by pathological examination in another hospital. The pathological results showed a high-grade squamous intraepithelial lesion (HSIL) in the biopsy specimen, and immunochemistry staining showed P16 positive, suggesting HPV infection. We performed pre-resection endoscopic examination for the patient. A lesion with a clear margin and tortuous dilated vessels was revealed under magnifying endoscopy with NBI (ME-NBI), which stayed unstained after iodine spraying. The lesion was successfully removed en bloc using ESD without complications, and the resected specimen was a low-grade squamous intraepithelial lesion (LSIL) with positive immunochemistry staining of P16. The patient underwent follow-up coloscopy a year after ESD, and the anal canal healed well with no suspicious lesions found. From this case, we can learn that ESD is safe and effective for curative resection of precancerous lesions of the anal canal.
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Affiliation(s)
- Hengcun Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing, China
| | - Xiujing Sun
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing, China
| | - Ling Yang
- Department of Gastroenterology, Beijing Fengtai Hospital, Beijing, China
| | - Rui Xu
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing, China
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Lajin M, Othman MO, Kamyar R, Armas O. Endoscopic submucosal dissection to treat squamous cell carcinoma in situ of the anal canal. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2022; 7:235-239. [PMID: 35693036 PMCID: PMC9174080 DOI: 10.1016/j.vgie.2022.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background and Aims The standard treatment for invasive squamous cell anal cancer is chemoradiation treatment. However, treatment options for high-grade dysplasia (squamous cell cancer in situ) are either surgical excision or topical treatment modalities. There are a few case reports, mainly from Japan, about resecting early squamous cell anal cancer (high-grade dysplasia/carcinoma in situ) by endoscopic submucosal dissection. We present a case series of 3 patients from a western hemisphere population with squamous carcinoma in situ of the anal canal resected with endoscopic submucosal dissection (ESD). Methods This is a retrospective series of 3 patients from a western hemisphere population with squamous carcinoma in situ of the anal canal resected with ESD. All patients were referred from the oncology team after declining surgical excision. Results Microscopically margin-negative en bloc resection was achieved in all patients. All patients were free from dysplasia or cancer on their latest endoscopic surveillance, ranging from 10 months to 26 months after ESD. One patient had a small lesion on follow-up 3 months after ESD that was removed by a curative EMR. There were no immediate or delayed adverse events. Conclusions ESD can be used to resect squamous cell carcinoma in situ of the anal canal. Larger studies with long-term follow-up are needed to evaluate the role of ESD in early squamous cell anal cancer and to compare it with other modalities of treatment.
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High-grade anal intraepithelial neoplasia treated with endoscopic submucosal dissection: a case report. Acta Gastroenterol Belg 2022; 85:108-110. [PMID: 35305003 DOI: 10.51821/85.1.8192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Anal intraepithelial neoplasia is a premalignant lesion for anal squamous cell carcinoma. Current treatment options, consisting of topical therapy and local ablative procedures with electrocautery or radiofrequency ablation, are effective although recurrence rates are high. Experience with endoscopic submucosal dissection for anal lesions is limited, with only a few cases of anal intraepithelial neoplasia and early anal squamous cell carcinoma. We present a 65-year-old woman with high-grade anal intraepithelial neoplasia successfully removed by endoscopic submucosal dissection with no complications or signs of recurrence after 5 months, suggesting that this technique could be a safe and effective approach for management of anal premalignant lesions.
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Boscolo Nata F, Tirelli G, Capriotti V, Marcuzzo AV, Sacchet E, Šuran-Brunelli AN, de Manzini N. NBI utility in oncologic surgery: An organ by organ review. Surg Oncol 2020; 36:65-75. [PMID: 33316681 DOI: 10.1016/j.suronc.2020.11.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/26/2020] [Indexed: 02/07/2023]
Abstract
The main aims of the oncologic surgeon should be an early tumor diagnosis, complete surgical resection, and a careful post-treatment follow-up to ensure a prompt diagnosis of recurrence. Radiologic and endoscopic methods have been traditionally used for these purposes, but their accuracy might sometimes be suboptimal. Technological improvements could help the clinician during the diagnostic and therapeutic management of tumors. Narrow band imaging (NBI) belongs to optical image techniques, and uses light characteristics to enhance tissue vascularization. Because neoangiogenesis is a fundamental step during carcinogenesis, NBI could be useful in the diagnostic and therapeutic workup of tumors. Since its introduction in 2001, NBI use has rapidly spread in different oncologic specialties with clear advantages. There is an active interest in this topic as demonstrated by the thriving literature. It is unavoidable for clinicians to gain in-depth knowledge about the application of NBI to their specific field, losing the overall view on the topic. However, by looking at other fields of application, clinicians could find ideas to improve NBI use in their own specialty. The aim of this review is to summarize the existing literature on NBI use in oncology, with the aim of providing the state of the art: we present an overview on NBI fields of application, results, and possible future improvements in the different specialties.
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Affiliation(s)
- Francesca Boscolo Nata
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy; Otorhinolaryngology Unit, Ospedali Riuniti Padova Sud "Madre Teresa di Calcutta", ULSS 6 Euganea, Via Albere 30, 35043, Monselice, PD, Italy.
| | - Giancarlo Tirelli
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Vincenzo Capriotti
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Alberto Vito Marcuzzo
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Erica Sacchet
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Azzurra Nicole Šuran-Brunelli
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Nicolò de Manzini
- General Surgery Unit, Department of Medical, Surgical and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
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Chai CY, Tran Cao HS, Awad S, Massarweh NN. Management of Stage I Squamous Cell Carcinoma of the Anal Canal. JAMA Surg 2019; 153:209-215. [PMID: 29049547 DOI: 10.1001/jamasurg.2017.3151] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Christy Y Chai
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Hop S Tran Cao
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Samir Awad
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Nader N Massarweh
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Houston Veterans Affairs (VA) Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
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Kaosombatwattana U, Yamamura T, Nakamura M, Hirooka Y, Goto H. Colorectal endoscopic submucosal dissection in special locations. World J Gastrointest Endosc 2019; 11:262-270. [PMID: 31040887 PMCID: PMC6475705 DOI: 10.4253/wjge.v11.i4.262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/17/2019] [Accepted: 03/26/2019] [Indexed: 02/06/2023] Open
Abstract
Colorectal endoscopic submucosal dissection (ESD) is considered one of the most challenging endoscopic procedures for novice endoscopists. When compared with the stomach, the colon and rectum have a narrower tubular lumen, greater angulation at the flexures, and a thinner muscle layer. These factors make endoscopic control and maneuverability difficult. ESD of the colorectum was considered more difficult than gastric and esophageal ESD. However, with learning from the experts, practicing, and selecting an appropriate technique, most of colorectal ESD could be performed successfully. Nevertheless, some colorectal locations are extremely specialized either from unique anatomy or given unstable scope position. Accordingly, the objective of this review was to provide endoscopists with an overview of the techniques and outcomes associated with ESD at these special colorectal locations. ESD at the discussed special locations of the ileo-colo-rectum was found to be feasible, and outcomes were comparable to those of ESD performed in non-special locations of the ileo-colo-rectum. Practice for skill improvement and awareness of the unique characteristics of each special location is the key to performing successful ESD.
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Affiliation(s)
- Uayporn Kaosombatwattana
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Takeshi Yamamura
- Department of Endoscopy, Nagoya University Hospital, Nagoya 466-8560, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan
| | - Yoshiki Hirooka
- Department of Endoscopy, Nagoya University Hospital, Nagoya 466-8560, Japan
| | - Hidemi Goto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan
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Kaosombatwattana U, Yamamura T, Nakamura M, Hirooka Y, Goto H. Colorectal endoscopic submucosal dissection in special locations. World J Gastrointest Endosc 2019. [DOI: 10.4253/wjge.v11.i4.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Uozumi T, Sumiyoshi T, Kondo H, Minagawa T, Fujii R, Yosida M, Tokuchi K, Mizukami T, Morita K, Ihara H, Okagawa Y, Takayama T, Ooiwa S, Hirayama M, Oyamada Y. Endoscopic submucosal dissection for early squamous cell carcinoma in the anal canal and Lugol chromoendoscopy for assessment of the lateral margin. Endosc Int Open 2018; 6:E1130-E1133. [PMID: 30211303 PMCID: PMC6133674 DOI: 10.1055/a-0584-7060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/23/2018] [Indexed: 01/16/2023] Open
Abstract
A 66-year-old man underwent follow-up colonoscopy after colon polypectomy. The retroflexed view of the anal canal with white-light imaging revealed a whitish, slightly elevated lesion on the dentate line and an ill-defined flat lesion. A biopsy of the whitish elevation revealed squamous cell carcinoma (SCC), and endoscopic submucosal dissection (ESD) was planned. The lateral margin of the SCC was identified by spraying with Lugol's iodine, and the tumor was resected en bloc with no complications. The pathological findings were SCC in situ with parakeratosis in the whitish elevation and high-grade intraepithelial neoplasia in the ill-defined flat lesion, which exhibited a wide iodine-unstained area by chromoendoscopy. Early SCC in the anal canal is a rare gastrointestinal cancer, and Lugol chromoendoscopy helped visualize the tumor margin for ESD.
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Affiliation(s)
- Takeshi Uozumi
- Department of Gastroenterology, Tonan Hospital, Sapporo, Japan,Corresponding author Takeshi Uozumi, MD Department of GastroenterologyTonan HospitalKita 4, Nishi 7, Chuo-ku, Sapporo, Hokkaido 060-0004, Japan+81 112618692
| | | | - Hitoshi Kondo
- Department of Gastroenterology, Tonan Hospital, Sapporo, Japan
| | | | - Ryoji Fujii
- Department of Gastroenterology, Tonan Hospital, Sapporo, Japan
| | - Masahiro Yosida
- Department of Gastroenterology, Tonan Hospital, Sapporo, Japan
| | - Kaho Tokuchi
- Department of Gastroenterology, Tonan Hospital, Sapporo, Japan
| | - Takuya Mizukami
- Department of Gastroenterology, Tonan Hospital, Sapporo, Japan
| | - Koutarou Morita
- Department of Gastroenterology, Tonan Hospital, Sapporo, Japan
| | - Hideyuki Ihara
- Department of Gastroenterology, Tonan Hospital, Sapporo, Japan
| | - Yutaka Okagawa
- Department of Gastroenterology, Tonan Hospital, Sapporo, Japan
| | | | - Shutaro Ooiwa
- Department of Gastroenterology, Tonan Hospital, Sapporo, Japan
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Wagner A, Neureiter D, Holzinger J, Kiesslich T, Klieser E, Berr F. Endoscopic submucosal dissection (ESD) for anal high-grade intraepithelial neoplasia: a case report. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2018; 56:495-498. [PMID: 29734448 DOI: 10.1055/a-0578-9059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Anal intraepithelial neoplasia (AIN) is a precursor of anal carcinoma. Conventional therapy is based on topical and local ablative approaches. However, the recurrence rates are very high, leading to repetitive treatment sessions and need for long-term surveillance. Endoscopic submucosal dissection (ESD) is an established treatment for malignant early neoplasias of the gastrointestinal tract, especially in the esophagus, stomach, and colorectum. Japanese centers have reported few cases of ESD for early anal carcinoma. We report a case of high-grade AIN diagnosed with magnifying narrow-band imaging and chromoendoscopy that was resected R0 with ESD en bloc.
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Affiliation(s)
- Andrej Wagner
- Department of Internal Medicine I, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Salzburg, Austria
| | - Daniel Neureiter
- Institute of Pathology, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Salzburg, Austria
| | - Josef Holzinger
- Department of Surgery, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Salzburg, Austria
| | - Tobias Kiesslich
- Laboratory for Tumour Biology and Experimental Therapies (TREAT), Institute of Physiology and Pathophysiology, Paracelsus Medical University, Salzburg, Austria
| | - Eckhard Klieser
- Institute of Pathology, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Salzburg, Austria
| | - Frieder Berr
- Department of Internal Medicine I, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Salzburg, Austria
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