Outcomes of endoscopic submucosal dissection for treatment of superficial anal squamous cell carcinoma: Multicenter international experience.

Background and study aims: Data on feasibility of endoscopic submucosal dissection (ESD) for treatment of superficial anal squamous cell carcinoma are limited. This study aimed to evaluate outcomes of ESD in this anatomical location. Patients and methods: This was a multicenter retrospective study including patients who underwent ESD for treatment of superficial ASCC. Results: Twenty-three patients with superficial ASCC were included. Median lesion size was 24 mm (range, 9-65 mm) and median procedure time was 62 minutes (range, 26-210 minutes). Accuracy of optical diagnosis using Japanese Endoscopic Society Intrapapillary capillary loops (IPCLs) classification to predict final histology was 63.6%. En bloc and R0 resection were achieved in 22 (95.6%) and 18 patients (78.3%), respectively. The curative resection rate was 73.9% (17/23). Three patients received additional complementary treatment. Delayed bleeding was observed in four patients (17.4%), two of whom required endoscopic hemostasis. Anal pain was reported in nine patients (39.1%) and was effectively managed with analgesics. Fecal incontinence and anal stenosis both occurred in one patient during the perioperative period. During median follow-up of 10.1 months (range, 0-69.6 months), no recurrences were observed. Conclusions: ESD is a feasible and effective treatment for superficial ASCC. Adverse events were successfully managed with medical or endoscopic therapy. ESD should be considered as first-line resection technique to prevent recurrence while preserving anal sphincter function.