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Abstract A positive resection margin after colorectal endoscopic submucosal dissection (ESD) is associated with an increased risk of recurrence. We aimed to identify the clinical significance of positive resection margins in colorectal neoplasms after ESD. We reviewed 632 patients who had en bloc colorectal ESD at two hospitals between 2015 and 2020. The recurrence rates and presence of residual tumor after surgery were evaluated. The rate of additional surgery after ESD and recurrence rate were significantly higher in patients with incomplete resection (n = 75) compared to patients with complete resection (n = 557). When focusing solely on non-invasive lesions, no significant differences in recurrence rates were observed between the groups with complete and incomplete resection (0.2% vs. 1.9%, p = 0.057). Among 84 patients with submucosal invasive carcinoma, 39 patients underwent additional surgery due to non-curative resection. Positive vertical margin and lymphovascular invasion were associated with residual tumor. Lymphovascular invasion was associated with lymph node metastasis. However, no residual tumor nor lymph node metastases were found in patients with only one unfavorable histological factor. In conclusion, a positive resection margin in non-invasive colorectal lesions, did not significantly impact the recurrence rate. Also, in T1 colorectal cancer with a positive vertical resection margin, salvage surgery can be considered in selected patients with additional risk factors.

Primary esophageal melanoma is a rare disease with a poor prognosis. To date, 18 cases have been reported in Korea. Four patients visited the Chonnam National University Hwasun Hospital with dysphagia, followed by epigastric pain and discomfort, odynophagia, and weight loss. Esophagogastroduodenoscopy revealed a black pigmented polypoid mass, protruding mass, or black-pigmented flat lesions. Two patients had distant metastases and lymphadenopathies in imaging studies. Two patients underwent esophagectomy and intrathoracic esophagogastrostomy. One patient was treated with chemotherapy and interferon-alpha. The other patient declined further treatment. The routine histology using H&E revealed brown-colored atypical melanocytes. Immunohistochemical staining exhibited strong reactivity for Melan-A, S-100, and HMB-45 proteins. The biopsy specimens were interpreted to be malignant melanoma. One patient had multiple distant metastases 13 months after surgery. The other patient had no recurrence for 33 months after surgery. The patient treated with chemotherapy and interferon-alpha showed disease progression in the follow-up examination. Primary esophageal melanoma in Korea is a rare disease characterized by aggressive behavior, early metastasis, and poor prognosis.

Background/Aims In recent years, a significant increase in incidence of rectal neuroendocrine tumors (NETs) has consequently increased in the importance of their optimal treatment and post-treatment management. Endoscopic resection has become a primary option for the treatment of grade 1 rectal NETs, less than 10 mm, but there is also a higher risk of residual tumors, compared to surgical resection. The study aimed to investigate the clinical outcomes of incompletely resected grade 1 rectal NETs and risk factors associated with prediction of residual tumors after salvage treatment. Methods Patients with grade 1 rectal NETs who underwent incomplete endoscopic resection from 2008 to 2023 were enrolled and their medical records were reviewed retrospectively. Finally, a total of 205 rectal NETs with the pathologic reports of incomplete resection were collected for data analysis. Results Among 205 patients, 76 patients received the salvage treatment and 126patients had been on a regular follow-up schedule without the salvage treatment. The mean follow-up period of enrolled patients was 35.0±37.6 months. The mean follow-up period of the salvage treatment and regular follow-up groups was 33.5±28.3 and 35.9±42.2 months, respectively. Local recurrence, metastasis, and disease-free survival rates did not show significant differences between the salvage treatment and regular follow-up groups. In the salvage treatment group, residual tumors were found in 23 (32.4%) patients. Primary endoscopic resection methods such as cold forceps, cold snare polypectomy, and conventional endoscopic mucosal resection (EMR), and primary endoscopic resection at non-tertiary medical center were the significant risk factors associated with residual tumors after the salvage treatment Conclusion Primary endoscopic resection methods such as cold forceps, cold snare polypectomy, and conventional EMR, and primary endoscopic resection at non-tertiary medical centers were the significant risk factors associated with prediction of the residual tumors after salvage treatment. [ABSTRACT FROM AUTHOR]