New indication for endoscopic treatment of colorectal carcinoma with submucosal invasion
New indication for endoscopic treatment of colorectal carcinoma with submucosal invasion
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DOI：
10.1111/j.1440-1746.2004.03261.x
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发表时间：
2004-01-01
影响因子：
4.1
通讯作者：
Kodama, T
中科院分区：
文献类型：
--
作者：
Shimomura, T;Ishiguro, S;Kodama, T
背景和目的：虽然越来越多的早期结直肠癌(CRC)已经被内窥镜治疗，但还没有一个确定的标准来决定这种治疗的有效性。方法：首先，对171例手术后病理组织学证实为黏膜下侵犯的结直肠癌患者的淋巴结转移危险因素进行分析。根据目前日本最常用的标准，对另外60例接受结直肠癌内窥镜切除和手术的患者进行了评估。结果：在第一项亚研究中，171名患者中有18名(10.5%)存在淋巴结转移。癌细胞的淋巴渗透、发芽和浸润性生长是与淋巴结转移密切相关的组织学因素，当黏膜下侵袭深度超过1500微米时，癌细胞的转移率更高。阳性淋巴结的最小深度为1075微米。在第二组60例患者中，符合我们的新的完全内窥镜治疗标准的9例患者中没有一例有淋巴结转移：黏膜下侵犯深度<1500微米，肿瘤组织学无淋巴渗透、发芽或浸润性生长模式。结论：本研究表明，早期结直肠癌的内窥镜治疗，当黏膜下侵犯超过1500微米，淋巴管渗出、发芽和浸润性生长均被排除时，可被认为是完全的。(C)2004年Blackwell出版亚洲私人有限公司。
Background and Aims: Although an increasing number of early colorectal cancers (CRC) have been curatively treated by endoscopy, there have been no definitive criteria to decide the effectiveness of such therapy. We retrospectively analyzed clinicopathological factors to establish criteria for curative endoscopic treatment of early CRC.Methods: First, risk factors of lymph node metastasis were analyzed in 171 patients who received surgery with postoperative histology of CRC submucosal invasion. The resultant new criteria were evaluated in another 60 patients who experienced endoscopic resection of CRC and surgery according to the current criteria most often used in Japan.Results: In the first substudy, lymph node metastasis was present in 18 of 171 patients (10.5%). Lymphatic permeation, sprouting and infiltrative growth of cancer cells were identified as histological factors significantly related to lymph node metastasis, and observed in much higher rates when the depth of submucosal invasion was beyond 1500 micron. The minimum depth with positive lymph nodes was 1075 micron. In the second group of 60 patients, lymph node metastasis was recorded in none of nine patients who met our new criteria of complete endoscopic treatment: submucosal invasion below 1500 micron in depth, and no lymphatic permeation, sprouting or infiltrative growth pattern on tumor histology. Lymph node metastasis was positive in three of the other cases who did not meet our new criteria.Conclusions: The present study showed that endoscopic treatment of early CRC may be considered complete when submucosal invasion beyond 1500 micron, lymphatic permeation, sprouting, and infiltrating growth are all denied. (C) 2004 Blackwell Publishing Asia Pty Ltd.