Role of rectal ESD in colorectal department - deem to be treatment of choice in localized rectal lesions?

Minimally invasive or endoscopic methods seem to be an opitmal choice for treatment of bening rectal lesions by achieving satisfactory oncological results, while neglecting the risk of operative trauma. The aim of this study was to evaluate the efficacy and safety results of ESD service in tertiary referral centre for colorectal disease in Poland. All ESD was performed by single surgeon only. Between 2013 and 2015 162 colorectal ESD was performed, among which 87 were localized in the rectum. In this group of patients, 70 patients did not undergo previous endoscopic resections, whereas in remaining 17 the tumor was recurrent. Overall en-block resection rate was 72% (62/86 cases) and was significantly lower in tumor above 5cm in diameter (56%, p 0,001). Follow up examinations after 3 months were conducted in 51 patients (59%). In three patients local recurrence was observed. Two patients underwent redo ESD, after which no further recurrence was observed. In remaining one, due to presence of malignancy in pathological report, salvage surgery was performed.In concern to oncological results, rectal ESD enables to safe tumor removal, regardless of size and location. Moreover, this is possible also in recurrent tumors, which previously was limited to TEM. Conversely, in low risk patients ESD should be stated as treatment of choice, enabling safe and complete resection with neglible rates of complications.