Short-term outcomes of endoscopic submucosal dissection versus laparoscopic surgery for colorectal neoplasms: An observational study
Short-term outcomes of endoscopic submucosal dissection versus laparoscopic surgery for colorectal neoplasms: An observational study
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DOI：
10.23922/jarc.2017-027
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发表时间：
2018-07-01
影响因子：
1.4
通讯作者：
Sho, Masayuki
中科院分区：
文献类型：
--
作者：
Inoue, Takashi;Koyama, Fumikazu;Sho, Masayuki
目的：随着内镜黏膜下剥离术和腹腔镜手术的发展，结直肠肿瘤的治疗已成为微创治疗。然而，很少有研究比较内镜粘膜下剥离术与腹腔镜手术治疗结直肠肿瘤，不包括术前诊断的深度浸润癌。研究方法：我们回顾性分析了2005年11月至2015年12月期间接受内镜粘膜下剥离术或腹腔镜手术治疗结直肠肿瘤的患者病例。我们将术前未被怀疑的患者限制为侵袭性粘膜下浸润> 1，000 μ m。结果：95例患者接受了内镜粘膜下剥离术，37例患者接受了腹腔镜手术。与腹腔镜手术相比，内镜粘膜下剥离术的病例往往涉及直肠肿瘤多于结肠肿瘤，手术时间更短，住院时间更短。早期（2005年11月至2010年12月）和晚期（2011年1月至2015年12月）结肠内镜粘膜下剥离术中的穿孔率分别为14.8%和2.9%。在结肠内窥镜粘膜下剥离术中穿孔的所有病例中，操纵内窥镜的能力都受到了影响。虽然直肠内镜黏膜下剥离术的患者肿瘤比结肠内镜黏膜下剥离术的患者大，但直肠内镜黏膜下剥离术的穿孔率和术后出血率均为3.2%。腹腔镜手术最常见的适应症是难以进行内镜粘膜下剥离术。严重并发症罕见。结论：对于结肠肿瘤，当内镜粘膜下剥离术在早期技术上有困难时，应考虑腹腔镜手术。对于直肠肿瘤，内镜下粘膜下剥离术是可取的，即使是那些大的大小。
Objectives: With endoscopic submucosal dissection and laparoscopic surgery, treatment for colorectal neoplasms has become minimally invasive. However, few studies have compared endoscopic submucosal dissection with laparoscopic surgery for colorectal neoplasms, excluding deeply invasive cancer on preoperative diagnosis. Methods: We retrospectively reviewed the files of patients who had undergone endoscopic submucosal dissection or laparoscopic surgery for colorectal neoplasms between November 2005 and December 2015. We limited patients who were not suspected preoperatively to have aggressive submucosal invasion >1,000 mu m. Results: Ninety-five patients underwent endoscopic submucosal dissection and 37 underwent laparoscopic surgery. Cases of endoscopic submucosal dissection tended to involve rectal neoplasms more often than colonic neoplasms, shorter operative times, and shorter lengths of hospital stay compared with laparoscopic surgery. The perforation rate during colonic endoscopic submucosal dissection in the early period (November 2005 to December 2010) and late period (January 2011 to December 2015) was 14.8% and 2.9%, respectively. In all cases of perforation during colonic endoscopic submucosal dissection, the ability to maneuver the endoscope was compromised. Though tumors were larger in patients who underwent rectal endoscopic submucosal dissection compared with colonic endoscopic submucosal dissection, the perforation and postoperative bleeding rates with rectal endoscopic submucosal dissection were both 3.2%. The most common indication for laparoscopic surgery was difficulty performing endoscopic submucosal dissection. Serious complications were rare. Conclusions: For colonic neoplasms, laparoscopic surgery should be considered when endoscopic submucosal dissection is technically difficult in the early period. For rectal neoplasms, endoscopic submucosal dissection is desirable even for those of large size.