Endoscopic resection of colorectal laterally spreading tumors: Clinicopathologic characteristics and risk factors for treatment outcomes

doi:10.4253/wjge.v17.i6.106412

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Jun 16, 2025 (publication date) through Jun 11, 2025

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World Journal of Gastrointestinal Endoscopy

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1948-5190

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastrointest Endosc. Jun 16, 2025; 17(6): 106412
Published online Jun 16, 2025. doi: 10.4253/wjge.v17.i6.106412

Table 1 Clinicopathological features of endoscopically resected laterally spreading tumors, n (%)

Variables	n = 375
Gender
Male	192 (51.2)
Female	183 (48.8)
Age (year), mean ± SD	63.25 ± 10.086 (32-88)
Smoking status (non-smoker/current or ex-smoker)	283 (75.5)/92 (24.5)
Alcohol drinking (no/yes)	298 (79.5)/77 (20.5)
BMI (kg/m²)	23.155 ± 2.885 (13.971-33.203)
Size (mm)	20.063 ± 10.078 (10-105)
Location
Cecum	25 (6.7)
Ascending colon	109 (29.1)
Transverse colon	88 (23.5)
Descending colon	37 (9.9)
Sigmoid colon	72 (19.2)
Rectum	44 (11.7)
Size (mm)
10-19 mm	189 (50.4)
20-29 mm	126 (33.6)
≥ 30 mm	60 (16.0)
Morphology
G-H	102 (27.2)
G-M	158 (42.1)
NG-F	83 (22.1)
NG-PD	32 (8.5)
Histologic grade
Low-grade dysplasia	226 (60.3)
High-grade dysplasia	95 (25.3)
Adenocarcinoma	54 (14.4)
Mucosal cancer	16 (4.3)
SM1 cancer	20 (5.3)
SM2 cancer	18 (4.8)
Resection method
EMR	63 (16.8)
ESD	312 (83.2)
Procedural characteristics
En bloc resection	361 (96.3)
R0 resection	350 (93.3)
Complications
Delayed bleeding	9 (2.4)
Minor perforation	18 (4.8)
Delayed perforation	1 (0.3)

BMI: Body mass index; LST: Laterally spreading tumor; G-H: Laterally spreading tumor granular homogeneous type; G-M: Laterally spreading tumor granular nodular mixed type; NG-F: Laterally spreading tumor non-granular flat elevated type; NG-PD: Laterally spreading tumor non-granular pseudo depressed type; SM1: Submucosal colorectal cancer with depth of invasion in the submucosa < 1000 μm; SM2: Submucosal colorectal cancer with depth of invasion in the submucosa ≥ 1000 μm; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection.

Table 2 Subgroup comparison between patients with laterally spreading tumor granular and non-granular laterally spreading tumor, n (%)

Variables	LST-G (n = 260)	LST-NG (n = 115)	χ²	P value
Gender			0.063	0.802
Male	132 (50.8)	60 (52.2)
Female	128 (49.2)	55 (47.8)
Age (years)			0.360	0.549
< 60	85 (32.7)	34 (29.6)
≥ 60	175 (67.3)	81 (70.4)
Smoking			0.971	0.324
No	200 (76.9)	32 (27.8)
Yes	60 (23.1)	83 (72.2)
Alcohol drinking			0.882	0.348
No	210 (80.8)	88 (76.5)
Yes	50 (19.2)	27 (23.5)
Location			5.642	0.060
Right colon	125 (48.1)	56 (48.7)
Left colon	98 (37.7)	52 (45.2)
Rectum	37 (14.2)	7 (6.1)
Size (mm)
10-19 mm	112 (43.1)	77 (67.0)	20.286	0.000
20-29 mm	96 (36.9)	30 (26.1)
≥ 30 mm	52 (20.0)	8 (7.0)
Histologic grade			7.491	0.024
Low-grade dysplasia	146 (56.2)	80 (69.6)
High-grade dysplasia	76 (29.2)	19 (16.5)
Adenocarcinoma	38 (14.6)	16 (13.9)
Mucosal caner	14 (5.4)	2 (1.7)
SM1 cancer	11 (4.2)	9 (7.8)
SM2 cancer	13 (5.0)	5 (4.3)
Resection method			6.760	0.009
EMR	35 (13.5)	28 (24.3)
ESD	225 (86.5)	87 (75.7)
Procedural characteristics
En bloc resection	250 (96.2)	111 (96.5)	0.030	0.862
R0 resection	242 (93.1)	108 (93.9)	0.090	0.765
Complications
Delayed bleeding	6 (2.3)	3 (2.6)	0.031	0.861
Perforation	13 (5.0)	6 (5.2)	0.008	0.929

LST-G: Laterally spreading tumor granular; LST-NG: Non-granular laterally spreading tumor; SM1: Submucosal colorectal cancer with depth of invasion in the submucosa < 1000 μm; SM2: Submucosal colorectal cancer with depth of invasion in the submucosa ≥ 1000 μm; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection.

Table 3 Subgroup comparison between patients with low-grade dysplasia and high-grade dysplasia/carcinoma, n (%)

Variables	Low-grade dysplasia (n = 226)	High-grade dysplasia/carcinoma (n = 149)	χ²	P value
Gender			6.114	0.013
Male	104 (46.0)	88 (59.1)
Female	122 (54.0)	61 (40.9)
Age (years)			0.268	0.605
< 60	74 (32.6)	45 (30.2)
≥ 60	152 (67.3)	104 (69.8)
Smoking			2.499	0.114
No	177 (78.3)	106 (71.1)
Yes	49 (21.7)	43 (28.9)
Alcohol drinking			3.743	0.053
No	187 (82.7)	111 (74.5)
Yes	39 (17.3)	38 (25.5)
Location			3.762	0.152
Right colon	109 (48.2)	72 (48.3)
Left colon	96 (42.5)	54 (36.2)
Rectum	21 (9.3)	23 (15.4)
Size (mm)			10.193	0.006
10-19 mm	128 (56.6)	61 (40.9)
20-29 mm	70 (31.0)	56 (37.6)
≥ 30 mm	28 (12.4)	32 (21.5)
LST subtype			27.866	0.000
G-H	67 (29.6)	35 (23.5)
G-M	79 (35.0)	79 (53.0)
NG-F	67 (29.6)	16 (10.7)
NG-PD	13 (5.8)	19 (12.8)
Resection method			11.534	0.001
EMR	50 (22.1)	13 (8.7)
ESD	176 (77.9)	136 (91.3)
Procedural characteristics
En bloc resection	218 (96.5)	143 (96.0)	0.059	0.808
R0 resection	215 (95.1)	135 (90.6)	2.960	0.085
Complications
Delayed bleeding	3 (1.3)	6 (4.0)	2.793	0.095
Perforation	10 (4.4)	9 (6.0)	0.487	0.485

LST: Laterally spreading tumor; G-H: Laterally spreading tumor granular homogeneous type; G-M: Laterally spreading tumor granular nodular mixed type; NG-F: Laterally spreading tumor non-granular flat elevated type; NG-PD: Laterally spreading tumor non-granular pseudo depressed type; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection.

Table 4 Univariate and multivariate analysis of predictors for high-grade dysplasia/carcinoma

Factors	Univariate		Multivariate
Factors	OR (95%CI)	P value	OR (95%CI)	P value
Sex
Male	1 (Reference)	-	1 (Reference)	-
Female	0.591 (0.389-0.898)	0.014	0.571 (0.367-0.889)	0.013
Age (years)
< 60	1 (Reference)	0.605	-	-
≥ 60	1.125 (0.720-1.759)	-	-	-
BMI (kg/m²)
< 24	1 (Reference)	-	-	-
≥ 24	0.916 (0.594-1.411)	0.689	-	-
Smoking
No	1 (Reference)	-	-	-
Yes	1.465 (0.911-2.356)	0.115	-	-
Alcohol drinking
No	1 (Reference)	-	-	-
Yes	1.641 (0.991-2.719)	0.054	-	-
Location
Right colon	1 (Reference)	-	-	-
Left colon	0.852 (0.545-1.331)	0.481	-	-
Rectum	1.658 (0.855-3.215)	0.135	-	-
Size (mm)
10-19 mm	1 (Reference)	-	1 (Reference)	-
20-29 mm	1.679 (1.054-2.673)	0.029	1.556 (0.953-2.542)	0.077
≥ 30 mm	2.398 (1.327-4.334)	0.004	1.934 (1.059-3.738)	0.032
LST subtype
G-H	1 (Reference)	-	1 (Reference)	-
G-M	1.914 (1.145-3.201)	0.013	2.100 (1.253-3.520)	0.005
NG-F	0.457 (0.231-0.904)	0.024	0.638 (0.315-1.292)	0.212
NG-PD	2.798 (1.238-6.323)	0.013	3.016 (1.239-7.339)	0.015

Table 5 Univariate and multivariate analysis of risk factors for submucosal invasion

Variables	Univariate		Multivariate
Variables	OR (95%CI)	P value	OR (95%CI)	P value
Sex
Male	1 (Reference)	-	-	-
Female	0.656 (0.331-1.301)	0.228	-	-
Age (years)
< 60	1 (Reference)	-	-	-
≥ 60	1.158 (0.554-2.420)	0.697	-	-
BMI (kg/m²)
< 24	1 (Reference)	-	-	-
≥ 24	1.060 (0.525-2.140)	0.871	-	-
Location
Right colon	1 (Reference)	-	-	-
Left colon	0.993 (0.472-2.088)	0.985	-	-
Rectum	1.925 (0.706-4.718)	0.214	-	-
Size (mm)
10-19	1 (Reference)	-	1 (Reference)	-
20-29	2.685 (1.129-6.387)	0.025	2.631 (1.066-6.494)	0.036
≥ 30	3.415 (1.333-8.752)	0.011	3.449 (1.260-9.443)	0.016
LST subtype
G-H	1 (Reference)	-	1 (Reference)	-
G-M	1.636 (0.653-4.097)	0.293	1.363 (0.536-3.470)	0.516
NG-F	0.687 (0.194-2.433)	0.561	0.845 (0.234-3.046)	0.797
NG-PD	6.169 (2.113-18.010)	0.001	6.506 (2.180-19.420)	0.001

Table 6 Univariate and multivariate analysis of risk factors for complications after endoscopic treatment of colorectal laterally spreading tumors

Variables	Univariate		Multivariate
Variables	OR (95%CI)	P value	OR (95%CI)	P value
Sex
Male	1 (Reference)	-	-	-
Female	1.229 (0.568-2.660)	0.600	-	-
Age (years)
< 60	1 (Reference)	-	-	-
≥ 60	0.703 (0.277-1.786)	0.459	-	-
BMI (kg/m²)
< 24	1 (Reference)	-	-	-
≥ 24	0.592 (0.227-1.541)	0.283	-	-
Location
Right colon	1 (Reference)	-	1 (Reference)	-
Left colon	0.377 (0.138-0.914)	0.032	0.351 (0.133-0.926)	0.034
Rectum	0.624 (0.176-2.210)	0.465	0.503 (0.134-1.83)	0.308
Size (mm)
10-19	1 (Reference)	-	1 (Reference)	-
20-29	1.740 (0.653-4.639)	0.268	1.870 (0.675-5.183)	0.228
≥ 30	5.079 (1.937-13.316)	0.001	4.888 (1.708-13.989)	0.003
LST subtype
G-H	1 (Reference)	-	1 (Reference)	-
G-M	3.718 (1.055-13.103)	0.041	3.382 (0.929-12.310)	0.064
NG-F	2.571 (0.623-10.612)	0.192	3.575 (0.826-15.470)	0.088
NG-PD	3.414 (0.654-17.828)	0.145	4.990 (0.904-27.533)	0.065
Histologic grade
Low-grade dysplasia	1 (Reference)	-	-	-
High-grade dysplasia	1.928 (0.814-4.564)	0.136	-	-
Adenocarcinoma	1.672 (0.569-4.909)	0.350	-	-
Resection method
EMR	1 (Reference)	-	-	-
ESD	0.577 (0.234-1.423)	0.233	-	-
Submucosa invasion
No	1 (Reference)	-	-	-
Yes	1.534 (0.503-4.684)	0.452	-	-

BMI: Body mass index; LST: Laterally spreading tumor; G-H: Laterally spreading tumor granular homogeneous type; G-M: Laterally spreading tumor granular nodular mixed type; NG-F: Laterally spreading tumor non-granular flat elevated type; NG-PD: Laterally spreading tumor non-granular pseudo depressed type; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; OR: Odds ratio; CI: Confidence interval.

Citation: Guo LH, Hu KF, Miao M, Ding Y, Zhang XJ, Ye GL. Endoscopic resection of colorectal laterally spreading tumors: Clinicopathologic characteristics and risk factors for treatment outcomes. World J Gastrointest Endosc 2025; 17(6): 106412
URL: https://www.wjgnet.com/1948-5190/full/v17/i6/106412.htm
DOI: https://dx.doi.org/10.4253/wjge.v17.i6.106412