• Laura W Leicher, Jelle F Huisman, Wilhelmina M U van Grevenstein, Paul Didden, Yara Backes, OfferhausG Johan AGJADepartment of Pathology, UMC Utrecht, Utrecht, The Netherlands., Miangela M Laclé, Freek C P Moll, Joost M J Geesing, Niels Smakman, DrosteJochim S Terhaar SiveJSTSDepartment of Gastroenterology & Hepatology, Jeroen Bosch Ziekenhuis, Den Bosch, The Netherlands., VerdaasdonkEmiel G GEGGDepartment of Surgery, Jeroen Bosch Ziekenhuis, Den Bosch, The Netherlands., Frank Ter Borg, A Koen Talsma, G Willemien Erkelens, Edwin S van der Zaag, Ruud Wm Schrauwen, Bob J van Wely, Ingrid Schot, Maarten Vermaas, Jeroen D van Bergeijk, Colin Sietses, Wouter L Hazen, Dareczka K Wasowicz, Dewkoemar Ramsoekh, Jurriaan B Tuynman, Yasser A Alderlieste, Rutger-Jan Renger, Frank A Oort, BilgenErnst Jan SpillenaarEJSDepartment of Surgery, Rijnstate, Arnhem, The Netherlands., Frank P Vleggaar, VasenHans F AHFADepartment of Gastroenterology & Hepatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands., Wouter H de Vos Tot Nederveen Cappel, MoonsLeon M GLMGDepartment of Gastroenterology & Hepatology, UMC Utrecht, Utrecht, The Netherlands., and Henderik L van Westreenen.
• Department of Gastroenterology & Hepatology, Isala, Zwolle, The Netherlands.
• Ann. Surg. 2022 May 1; 275 (5): 933-939.

ObjectiveThe aim of this study was to evaluate the safety and efficacy of a modified CAL-WR.Summary Background DataThe use of segmental colectomy in patients with endoscopically unresectable colonic lesions results in significant morbidity and mortality. CAL-WR is an alternative procedure that may reduce morbidity.MethodsThis prospective multicenter study was performed in 13 Dutch hospitals between January 2017 and December 2019. Inclusion criteria were (1) colonic lesions inaccessible using current endoscopic resection techniques (judged by an expert panel), (2) non-lifting residual/recurrent adenomatous tissue after previous polypectomy or (3) an undetermined resection margin after endoscopic removal of a low-risk pathological T1 (pT1) colon carcinoma. Thirty-day morbidity, technical success rate and radicality were evaluated.ResultsOf the 118 patients included (56% male, mean age 66 years, standard deviation ± 8 years), 66 (56%) had complex lesions unsuitable for endoscopic removal, 34 (29%) had non-lifting residual/recurrent adenoma after previous polypectomy and 18 (15%) had uncertain resection margins after polypectomy of a pT1 colon carcinoma. CAL-WR was technically successful in 93% and R0 resection was achieved in 91% of patients. Minor complications (Clavien-Dindo i-ii) were noted in 7 patients (6%) and an additional oncologic segmental resection was performed in 12 cases (11%). Residual tissue at the scar was observed in 5% of patients during endoscopic follow-up.ConclusionsCAL-WR is an effective, organ-preserving approach that results in minor complications and circumvents the need for major surgery. CAL-WR, therefore, deserves consideration when endoscopic excision of circumscribed lesions is impossible or incomplete.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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