{
  "abstract": "Background For large non-pedunculated rectal polyps, en bloc resection via endoscopic submucosal dissection (ESD) is typically recommended due to presumed higher risk of submucosal invasive cancer (SMIC) compared with the colon; however, data on cancer risk by location remain controversial.Objective Using the French ESD registry, we compared SMIC rates in large non-pedunculated colorectal polyps in the rectum versus colon. Procedural outcomes were also compared.Design From September 2019 to September 2022, all large non-pedunculated polyps resected by ESD in 13 centres were included. Oncological and procedural outcomes were analysed using propensity score matching (PSM) and inverse probability weighting, accounting for relevant influencing factors. A subgroup analysis was performed on cases from the three largest centres, where such polyps were exclusively treated with ESD.Results Among 3770 lesions, 3310 were analysed. Rectal lesions were larger (56.0 (40; 75) mm vs 47.0 (37; 62) mm), more often granular (80.0% vs 59.4%) and mixed nodular (54.0% vs 32.5%) (p<0.001). After PSM, submucosal cancer rates were not significantly different between rectal and colonic lesions of similar size and morphology (9.8% vs 8.9%, p=0.52). En bloc (97.7% vs 97.3%, p=0.757) and R0 resection rates (89.7% vs 89.5%, p=0.937) were also comparable. Perforation (5.5% vs 7.9%, p=0.057) and surgery for complications (0.1% vs 1.1%, p=0.051) showed a non-significant trend towards higher rates in colonic procedures. Subgroup analysis from the three centres exclusively performing ESD for large non-pedunculated polyps confirmed these findings.Conclusion In our multicentre registry, large non-pedunculated polyps do not show a higher prevalence of SMIC in the rectum compared with colon, when adjusted for relevant factors such as size and morphology. Therefore, risk features, rather than location, should guide the choice of resection technique. Technical outcomes were comparable between rectal and colonic ESD, with a trend for higher complication rates in the colon.Trial registration number NCT04592003.",
  "authors": [
    {
      "affiliations": [
        "Department of Gastroenterology and Endoscopy, CHU Limoges, Limoges, France"
      ],
      "name": "Veronique Van der Voort"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Nancy Regional University Hospital Center, Nancy, France"
      ],
      "name": "Marion Schaefer"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Rennes University Hospital, Pontchaillou Site, Rennes, France"
      ],
      "name": "Timothee Wallenhorst"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Endoscopy, Jean Mermoz Private Hospital, Ramsay Santé, Lyon, France"
      ],
      "name": "Vincent Lepilliez"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Endoscopy, University Hospital Centre Dijon, Dijon, France"
      ],
      "name": "Thibault Degand"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Endoscopy, Hospital Saint Joseph, Paris, France"
      ],
      "name": "Yann Le Baleur"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Groupe Santé CHC, Liege, Belgium"
      ],
      "name": "Philippe Leclercq"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, University Hospital Centre Bordeaux, Bordeaux, France"
      ],
      "name": "Arthur Berger"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Anjou Clinic, Angers, France"
      ],
      "name": "Edouard Chabrun"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Jules Verne Clinic, Nantes, France"
      ],
      "name": "Bertrand Brieau"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, Paris, France"
      ],
      "name": "Maximilien Barret"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Endoscopy, Hôpital Européen Georges-Pompidou, Paris, France"
      ],
      "name": "Gabriel Rahmi"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Endoscopy, CHU Limoges, Limoges, France"
      ],
      "name": "Romain Legros"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Endoscopy, Hôpital Edouard Herriot, Lyon, France"
      ],
      "name": "Jérôme Rivory"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Endoscopy, Jean Mermoz Private Hospital, Ramsay Santé, Lyon, France"
      ],
      "name": "Sarah Leblanc"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, University Hospital Centre Nice, Nice, France"
      ],
      "name": "Geoffroy Vanbiervliet"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Endoscopy, IRCCS Humanitas Research Hospital, Milan, Italy"
      ],
      "name": "Ludovico Alfarone"
    },
    {
      "affiliations": [
        "Department of Epidemiology, Biostatistics and Research Methodology, University of Limoges, Limoges, France"
      ],
      "name": "Julien Magne"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Groupe Santé CHC, Liege, Belgium"
      ],
      "name": "Jean-Baptiste Zeevaert"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Endoscopy, CHU Limoges, Limoges, France"
      ],
      "name": "Jérémie Albouys"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Endoscopy, Hôpital Européen Georges-Pompidou, Paris, France"
      ],
      "name": "Guillaume Perrod"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Hôpital Edouard Herriot, Lyon, France"
      ],
      "name": "Clara Yzet"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Endoscopy, CHU Limoges, Limoges, France"
      ],
      "name": "Hugo Lepetit"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Hôpital Cochin, Paris, France"
      ],
      "name": "Arthur Belle"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Hôpital Cochin, Paris, France"
      ],
      "name": "Stanislas Chaussade"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Hôpital Edouard Herriot, Lyon, France"
      ],
      "name": "Florian Rostain"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, University Hospital Centre Bordeaux, Bordeaux, France"
      ],
      "name": "Martin Dahan"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Endoscopy, Hôpital Edouard Herriot, Lyon, France"
      ],
      "name": "Alexandru Lupu"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Hôpital Edouard Herriot, Lyon, France"
      ],
      "name": "Jean-Baptiste Chevaux"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Endoscopy, Hôpital Edouard Herriot, Lyon, France"
      ],
      "name": "Mathieu Pioche"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Endoscopy, CHU Limoges, Limoges, France",
        "Department of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada"
      ],
      "name": "Jérémie Jacques"
    },
    {
      "affiliations": [],
      "name": "On behalf of FECCo Group collaborators"
    }
  ],
  "title": "Rectal versus colonic submucosal cancer rates and procedural outcomes in large non-pedunculated polyps: French ESD registry data",
  "uid": "80bc183d-5866-5367-ad58-55895a33fe31"
}