AbstractObjectivesEndoscopic submucosal dissection (ESD) is an effective procedure for the en bloc resection of colorectal neoplasms. However, risk factors for local recurrence after ESD have not been identified. This study aimed to evaluate such risk factors after ESD for colorectal neoplasms.MethodsThis retrospective study included 1344 patients with 1539 consecutive colorectal lesions who underwent ESD between September 2003 and December 2019. We investigated various factors associated with local recurrence in these patients. The main outcomes were the incidence of local recurrence and its relationship with clinicopathological factors during long‐term surveillance.ResultsThe en bloc resection rate was 98.6%, the R0 resection rate was 97.2%, and the histologically complete resection rate was 92.7%. Local recurrence was observed in 7/1344 (0.5%) patients and the median follow‐up period was 72 months (range 4–195 months). The incidence of local recurrence was significantly higher in lesions ≥40 mm in diameter (hazard ratio [HR] 15.68 [1.88–130.5]; p = 0.011), piecemeal resection (HR 48.42 [10.7–218.7]; p < 0.001), non‐R0 resection (HR 41.05 [9.025–186.7]; p < 0.001), histologically incomplete resection (HR 16.23 [3.627–72.63]; p<0.001), and severe fibrosis (F2; HR 9.523 [1.14–79.3]; p = 0.037).ConclusionsFive risk factors for local recurrence after ESD were identified. Patients with such factors should undergo careful surveillance colonoscopy.