Large or complex colon polyps are in general removed with advanced endoscopic resection techniques such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (eFTR). However, not all colonic lesions are eligible to be removed by these minimal invasive endoscopic techniques because of their size, morphology or difficult approachable location. As a result, a large proportion of patients is still referred for a segmental colon resection, which is known to be associated with complications in 25% of all patients and a mortality rate of 1-2%. Therefore, we introduced the colonoscopic-assisted laparoscopic wedge resection (CAL-WR) by using a linear stapler without anastomosis for the treatment of such polyps.
In the prospective multicenter LIMERIC-study (Annals of Surgery 275-5:p 933-939, May 2022), it was demonstrated that CAL-WR is a safe and feasible technique for the resection of colonic polyps not amenable to conventional endoscopic resection. CAL-WR has a low morbidity rate, with only 6% minor complications, a high technical success rate (93%) and a radical resection rate of 91%.
Subsequently, CAL-WR was introduced as a feasible ‘’full-thickness’’ resection technique for the removal of suspected T1 colon carcinomas (Annals of Surgical Oncology January 2023). In particular for large deep-invasive lesions, CAL-WR could fill the gap between the current endoscopic resection techniques and major oncologic surgery, providing more patients an minimal invasive organ-preserving treatment option.
CAL-WR is a promising local resection technique for both superficial and deep-invasive T1 colon cancer; however, its long-term oncological outcomes are not yet known. Therefore, a large, prospective, multicenter study (the LIMERIC-II) has currently started in the Netherlands, which will provide more insight in the long-term oncological outcomes, patients burden, as well as costs.
For more information about the LIMERIC or LIMERIC-II study, including study-related resources (protocol, patient information per site), please click on the relevant study.
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Colonoscopy-Assisted Laparoscopic Wedge Resection for the Treatment of Suspected T1 Colon Cancer.
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