Endoscopic Submucosal Dissection for Colorectal Epithelial Neoplasms
Endoscopic Submucosal Dissection for Colorectal Epithelial Neoplasms
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DOI：
10.1007/dcr.0b013e3181b78cb6
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发表时间：
2010-02-01
影响因子：
3.9
通讯作者：
Shikuwa, Saburo
中科院分区：
文献类型：
--
作者：
Nishiyama, Hitoshi;Isomoto, Hajime;Shikuwa, Saburo
目的：内窥镜下黏膜下剥离术可以整块切除大肠上皮性肿瘤，但长期临床效果尚不清楚。方法：282例患者296个符合纳入标准的大肠肿瘤，包括直径大于20 mm的肿瘤，其中直径大于20 mm的病灶很难通过胃镜整块切除，先前的内窥镜治疗或活检有纤维瘢痕的病变，内窥镜下切除后局部残留的病变，或浸润性癌粘膜下轻度穿透。评估肿瘤整块或分段切除、完全切除(无肿瘤侧缘/基底缘)或不完全切除以及并发症，并用Logistic回归分析与各因素相关的因素。对早期结肠癌患者进行了中位34个月的内窥镜随访和转移调查。结果：89.2%(264/296)的患者获得了完整切除，234个病变(79.1%)被认为完全切除。右侧结肠位置是不完全切除的重要因素。穿孔24例(8.1%)，与肿瘤大小和纤维化的存在有关。肿瘤局部复发不完全切除1例，完全切除组无复发和残留。没有观察到与癌症相关或与癌症无关的死亡。结论：准确评估成功的整块切除的治愈性可能会减少内窥镜下黏膜下切除术后的肿瘤复发。接受内窥镜下粘膜下清扫术治疗的早期结直肠癌患者的预后可能很好，尽管还需要进一步更长时间的随访研究。
PURPOSE: Endoscopic submucosal dissection permits removal of colorectal epithelial neoplasms en bloc, but long-term clinical outcomes remain unknown.METHODS: Endoscopic submucosal dissection was performed in 282 patients having 296 colorectal tumors that fulfilled the inclusion criteria, which included lesions greater than 20 mm in size for which en bloc resection would be difficult with endoscopic mucosal resection, lesions with fibrotic scar due to previous endoscopic treatment or biopsies, locally residual lesions after endoscopic resection, or invasive carcinoma with slight submucosal penetration. En bloc or piecemeal resection, complete (en bloc with tumor-free lateral/basal margins) or incomplete resection, and complications were assessed, and factors related to each were analyzed using logistic regression. Patients with early colon cancer received endoscopic follow-up and metastatic surveys for a median of 34 months.RESULTS: En bloc resection was achieved in 89.2% (264/296) and 234 lesions (79.1%) were deemed to have undergone complete resection. A right-side colonic location was the significant contributor to incomplete resection. Perforation was seen in 24 cases (8.1%) in association with tumor size and the presence of fibrosis. There was 1 case of locally recurrent tumor with incomplete resection, whereas neither recurrence nor residual disease was observed in the complete resection group. Neither cancer-related nor cancer-unrelated death was observed.CONCLUSIONS: Precise assessment of curability with successful en bloc resection may reduce tumor recurrence after endoscopic submucosal dissection. The prognosis of early colorectal cancer in patients treated by endoscopic submucosal dissection is likely to be excellent, although further longer follow-up studies are warranted.