Management of sessile malignant polyps: is colonoscopic polypectomy enough?
Management of sessile malignant polyps: is colonoscopic polypectomy enough?
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无蒂恶性息肉的治疗：结肠镜息肉切除术足够吗？
DOI：
10.1007/s00464-014-4027-3
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发表时间：
2015-10-01
影响因子：
3.1
通讯作者：
Church, James M.
中科院分区：
文献类型：
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作者：
Wu, Xian-rui;Liang, Jennifer;Church, James M.
背景研究了内窥镜检查在恶性细胞息肉的管理中的作用，但对恶性为静脉息肉的内窥镜治疗却没有。有时，有恶性为息肉的患者合并症会使手术异常冒险，并且内窥镜检查作为确定的管理选择。这项研究的目的是评估内窥镜检查在1997年至2010年的单个内窥镜检查中对结肠镜息肉切除术进行恶性静脉息肉进行结肠镜息肉切除术的潜在作用。记录了人口统计数据，临床病理变量以及长期结局。16例患者患有恶性为息肉。六名（37.5％）是男性，女性为10（62.5％）。诊断时的平均年龄为72.9 +/- A 12.2岁。六个息肉与脾弯曲近端（37.5％），远端为10（62.5％）。息肉的平均大小为30.5 +/- A 15.9毫米。所有息肉均通过内窥镜去除，但结肠镜切除后7例（43.8％）进行了正式的结肠切除术。有和没有手术的患者之间没有人口统计学差异。在8例，手术组的4例中，需要进行分散的息肉切除术，其中4例来自内窥镜组。手术组中的越来越多的患者分化较差（4/6 vs. 0/6）和不完全的边缘（5/6 vs. 1/6），并且内镜治疗组中的患者有更多的合并症（5/9 vs. 3/7）。没有与程序有关的发病率或死亡率。在平均随访48.4 +/- a 27.2个月后，一名来自多型切除术组患者的患者最初在手术下降后，患有局部复发和肝转移。在手术组中，一名患者患有肺转移。遥远转移的两名患者死于遥远的内窥镜治疗，对有良好/中等分化的癌症和负缘的患者，无镜头结直肠息肉的判断似乎是可行且安全的。需要大量研究来确认这些发现。
Background The role of endoscopy in the management of malignant-pedunculated polyps has been well studied, but endoscopic management of malignant sessile polyps has not. Sometimes patients with malignant sessile polyps have comorbidities that make surgery exceptionally risky, and endoscopy beckons as a definitive management option. The aim of this study is to evaluate the potential role of endoscopy in the management of malignant sessile polyps.Methods Patients undergoing colonoscopic polypectomy for malignant sessile polyps by a single endoscopist from 1997 to 2010 were evaluated. Demographic data, clinicopathological variables as well as long-term outcomes were recorded.Results Sixteen patients had malignant sessile polyps. Six (37.5 %) were male and 10 (62.5 %) were female. Mean age at diagnosis was 72.9 +/- A 12.2 years. Six polyps were proximal to the splenic flexure (37.5 %) and 10 (62.5 %) were distal. The mean size of the polyps was 30.5 +/- A 15.9 mm. All polyps were removed endoscopically but 7 patients (43.8 %) had formal colectomy following colonoscopic resection. There were no demographic differences between patients with and without surgery. Piecemeal polypectomy was necessary in 8 patients, 4 from the surgery group, and 4 from the endoscopy group. More patients in the surgery group had poorly differentiated cancers (4/6 vs. 0/6) and incomplete margins (5/6 vs. 1/6) and more patients in the endoscopically treated group had serious comorbidity (5/9 vs. 3/7). There was no procedure-related morbidity or mortality. After a mean follow-up of 48.4 +/- A 27.2 months, one patient from the polypectomy group patient had a local recurrence and a liver metastasis, after originally declining surgery. In the surgery group, one patient had lung metastasis. The two patients who recurred with distant metastasis died.Conclusion Endoscopic management of sessile colorectal polyps appears to be feasible and safe in patients with well/moderately differentiated cancer and negative margins. Larger studies are needed to confirm these findings.