Resection outcomes and recurrence rates of endoscopic submucosal dissection (ESD) and hybrid ESD for colorectal tumors in a single Italian center
Resection outcomes and recurrence rates of endoscopic submucosal dissection (ESD) and hybrid ESD for colorectal tumors in a single Italian center
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DOI：
10.1007/s00464-017-5928-8
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发表时间：
2018-05-01
影响因子：
3.1
通讯作者：
Testoni, Pier Alberto
中科院分区：
文献类型：
--
作者：
Milano, Reza V.;Viale, Edi;Testoni, Pier Alberto
内镜粘膜下剥离术 (ESD) 和混合 ESD 技术是结直肠肿瘤的治疗方式，但主要用于东半球。西方仅发表了少量关于结直肠肿瘤 ESD 的数据。我们报告了意大利一家中心的结直肠 ESD 和混合 ESD 的结果。我们根据前瞻性记录的数据库回顾性评估了前 2 年中针对结直肠肿瘤进行的所有 ESD 和混合 ESD 手术的结果。排除粘膜下（SM）2层或更深层浸润的神经内分泌肿瘤和腺癌。主要结局是 6 至 12 个月随访时的复发率。该研究纳入了 52 名患者，其中 23 名患者接受了 ESD，29 名患者接受了混合 ESD。 ESD 和混合 ESD 的平均病灶大小相似（25.8 毫米与 25.4 毫米，p = 0.940），而 ESD 的中位手术时间明显更长（120 分钟与 60 分钟，p < 0.001）。 ESD 和混合 ESD 产生相似的整块切除率（82.6 vs. 82.8%）和 R0 切除率（34.8 vs. 31%）。与混合 ESD 相比，ESD 的肿瘤复发率较低（11.7% vs. 20%），出血率也较低（0% vs. 8.7%）。混合 ESD 组发生 1 例穿孔，ESD 组发生 2 例穿孔，其中 1 例需要手术干预。随访时不复发与 R0 状态、整块切除和病变大小 20 毫米相关。我们的结果与西方系列的其他研究相当。需要研究解决 ESD 的成本效益，并将其长期结果与西方的内镜粘膜切除术进行比较。
Endoscopic submucosal dissection (ESD) and hybrid-ESD techniques are treatment modalities for colorectal neoplasia, although mostly used in the Eastern hemisphere. Only few data on ESD for colorectal neoplasia have been published in the West. We report the outcomes of colorectal ESD and hybrid ESD in a single Italian center.We retrospectively evaluated the outcomes of all ESD and hybrid-ESD procedures for colorectal neoplasia performed over the first 2-year experience from a prospectively recorded database. Neuroendocrine tumors and adenocarcinoma with submucosal infiltration through the submucosal (SM) 2 layer or deeper were excluded. The primary outcome was the recurrence rate at the 6- to 12-month follow-up.Fifty-two patients were included in the study, of which 23 underwent ESD and 29 hybrid ESD. The mean lesion sizes for ESD and hybrid ESD were similar (25.8 vs. 25.4 mm, p = 0.940), while median procedure length was significantly longer for ESD (120 vs. 60 min, p < 0.001). ESD and hybrid ESD yielded similar en-bloc resection rate (82.6 vs. 82.8%) and R0 resection rate (34.8 vs. 31%). ESD had a lower neoplasia recurrence rate than hybrid ESD (11.7 vs. 20%) and a lower bleeding rate (0 vs. 8.7%). One perforation occurred in the hybrid-ESD cohort and two perforations in the ESD cohort, of which one required surgical intervention. Non-recurrence at follow-up was associated with R0 status, en-bloc resection, and lesion size 20 mm.Our outcomes are comparable with other studies in Western series. Studies addressing the cost effectiveness of ESD and comparing its long-term outcome with endoscopic mucosal resection in the West are needed.