Indications for Subsequent Surgery After Endoscopic Resection of Submucosally Invasive Colorectal Carcinomas: A Prospective Cohort Study
Indications for Subsequent Surgery After Endoscopic Resection of Submucosally Invasive Colorectal Carcinomas: A Prospective Cohort Study
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DOI：
10.1007/dcr.0b013e318197e37f
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发表时间：
2009-03-01
影响因子：
3.9
通讯作者：
Jeong, Seung-Yong
中科院分区：
文献类型：
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作者：
Choi, Dong Hyun;Sohn, Dae Kyung;Jeong, Seung-Yong
目得：本研究探讨了影响内镜切除术后粘膜下浸润性结直肠癌患者手术切除或非手术随访后肿瘤学结局的预测因素。方法：根据切除边缘、组织学和浸润深度评估淋巴结转移或肿瘤复发方面的肿瘤学结局。结果：对87例内镜切除术后粘膜下浸润性结直肠癌患者进行前瞻性随访。57例（65.5%）患者存在深层粘膜下浸润和/或组织学不良的风险因素。其中30例行根治性切除术，6例有淋巴结转移。对20例有危险因素的患者进行了密切随访，发现3例复发癌。最终，57例高危患者中有9例（15.8%）出现淋巴结转移或肿瘤复发。无危险因素的30例患者中，无淋巴结转移或复发癌。单因素分析显示，肿瘤出芽（P = 0.003）和静脉侵犯（P = 0.021）是淋巴结转移的影响因素。在多变量分析中，只有肿瘤出芽是淋巴结转移的独立预测因子（P = 0.026）。结论：大约16%的粘膜下浸润性结直肠癌患者和危险因素受益于后续手术。肿瘤出芽是淋巴结转移的最重要因素。对于内镜切除术后无危险因素的患者，观察是适当的。
PURPOSE: This study explored predictive factors that affected oncologic outcomes after surgical resection or follow-up without surgery in patients with submucosally invasive colorectal carcinomas after endoscopic resection.METHODS: Oncologic outcomes in terms of lymph node metastasis or tumor recurrence were assessed according to resection margin, histology, and depth of invasion.RESULTS: Eighty-seven patients with submucosally invasive colorectal carcinomas after endoscopic resection were followed prospectively. Fifty-seven (65.5 percent) patients had risk factors of deep submucosal invasion and/or unfavorable histology. Among them, 30 underwent radical resection, and 6 patients had lymph node metastases. Twenty patients with risk factors were closely followed up and 3 recurrent carcinomas were detected. Ultimately, 9 of 57 high-risk patients (15.8 percent) exhibited lymph node metastasis or tumor recurrence. Among 30 patients without risk factors, none had lymph node metastasis or recurrent carcinoma. Univariate analysis showed that tumor budding (P = 0.003) and venous invasion (P = 0.021) were factors for lymph node metastasis. In multivariate analysis, only tumor budding was an independent predictor of lymph node metastasis (P = 0.026).CONCLUSIONS: Approximately 16 percent of patients with submucosally invasive colorectal carcinoma and risk factors benefited from subsequent surgery. Tumor budding was the most significant factor for lymph node metastasis. Observation would be appropriate for patients without risk factors after endoscopic resection.