Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jun 16, 2025; 17(6): 106412
Published online Jun 16, 2025. doi: 10.4253/wjge.v17.i6.106412
Endoscopic resection of colorectal laterally spreading tumors: Clinicopathologic characteristics and risk factors for treatment outcomes
Li-Hua Guo, Ke-Feng Hu, Min Miao, Yong Ding, Xin-Jun Zhang, Guo-Liang Ye
Li-Hua Guo, Ke-Feng Hu, Min Miao, Yong Ding, Xin-Jun Zhang, Guo-Liang Ye, Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, Ningbo 315020, Zhejiang Province, China
Author contributions: Guo LH performed a literature search and wrote the manuscript; Hu KF, Miao M, Ding Y, and Zhang XJ had full access to all data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis; Ye GL reviewed the manuscript accordingly; Guo LH, Hu KF, Miao M, Ding Y, Zhang XJ, and Ye GL contributed to data curation; and all authors thoroughly reviewed and endorsed the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Faculty of the First Affiliated Hospital of Ningbo University, approval No. 2024-083RS.
Informed consent statement: Informed consent was obtained by opting out, not in writing, as this is a retrospective analysis.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
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: Guo-Liang Ye, Full Professor, Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, No. 247 Renmin Road, Jiangbei District, Ningbo 315020, Zhejiang Province, China. ndfyygl@163.com
Received: March 7, 2025
Revised: April 9, 2025
Accepted: May 8, 2025
Published online: June 16, 2025
Processing time: 96 Days and 13.7 Hours
Abstract
BACKGROUND

Colorectal laterally spreading tumors (LSTs) are best treated with endoscopic submucosal dissection or endoscopic mucosal resection.

AIM

To analyze the clinicopathological and endoscopic profiles of colorectal LSTs, determine predictive factors for high-grade dysplasia (HGD)/carcinoma (CA), submucosal invasion, and complications.

METHODS

We retrospectively assessed the endoscopic and histological characteristics of 375 colorectal LSTs at our hospital between January 2016 and December 2023. We performed univariate and multivariate analysis to identify risk factors associated with HGD/CA, submucosal invasion and complications.

RESULTS

The numbers of granular (LST-G) and non-granular LST (LST-NG) were 260 and 115, respectively. The rates of low-grade dysplasia and HGD/CA were 60.3% and 39.7%, respectively. Multivariate analysis indicated that a tumor size ≥ 30 mm [odds ratio (OR) = 1.934, P = 0.032], LST granular nodular mixed type (OR = 2.100, P = 0.005), and LST non-granular pseudo depressed type (NG-PD) (OR = 3.016, P = 0.015) were independent risk factors significantly associated with higher odds of HGD/CA. NG-PD (OR = 6.506, P = 0.001), tumor size (20-29 mm) (OR = 2.631, P = 0.036) and tumor size ≥ 30 mm (OR = 3.449, P = 0.016) were associated with increased odds of submucosal invasion. Tumor size ≥ 30 mm (OR = 4.888, P = 0.003) was a particularly important predictor of complications. A nomogram model demonstrated a satisfactory fit, with an area under the receiver operating characteristic curve of 0.716 (95% confidence interval: 0.653-0.780), indicating strong predictive performance.

CONCLUSION

The novel nomogram incorporating tumor size, location, and morphology predicted HGD/CA during endoscopic resection for LSTs. NG-PD lesions larger than 20 mm were more likely to invade the submucosa. Tumor size ≥ 30 mm was an important predictor of complications.

Keywords: Colorectal neoplasms; Laterally spreading tumor; Endoscopic morphology; Endoscopic submucosal dissection; Endoscopic mucosal resection; Submucosal invasion

Core Tip: We retrospectively analyzed 375 colorectal laterally spreading tumors (LSTs) at our hospital between January 2016 and December 2023. Univariate and multivariate analyses were performed to identify risk factors for high-grade dysplasia/carcinoma, submucosal invasion and complications. The novel nomogram incorporated tumor size, location, and morphology for predicting high-grade dysplasia/carcinoma during endoscopic resection for LSTs. Multivariate analysis indicated that LST non-granular pseudo depressed type lesions larger than 20 mm had a significantly higher probability of submucosal invasion. Additionally, tumor size ≥ 30 mm emerged as a critical predictor of complications.