Vertical tumor margin of endoscopic resection for T1 colorectal carcinoma affects the prognosis of patients undergoing additional surgery
Vertical tumor margin of endoscopic resection for T1 colorectal carcinoma affects the prognosis of patients undergoing additional surgery
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T1期结直肠癌内镜切除垂直瘤缘对追加手术患者预后的影响
DOI：
10.1007/s00464-021-08977-y
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Tanaka Shinji
中科院分区：
文献类型：
--
作者：
Nishimura Tomoyuki;Oka Shiro;Kamigaichi Yuki;Tamari Hirosato;Shimohara Yasutsugu;Okamoto Yuki;Inagaki Katsuaki;Tanaka Hidenori;Yamashita Ken;Yuge Ryo;Urabe Yuji;Arihiro Koji;Shimamoto Fumio;Tanaka Shinji
背景垂直肿瘤边缘阴性的T1结直肠癌（CRC）是完全内镜切除（ER）后的绝对治愈性疾病。然而，垂直肿瘤边缘对预后的影响尚不清楚。因此，我们评估了垂直肿瘤边缘到切除标本边缘的距离的影响T1b的ER（垂直边缘距离）（粘膜下浸润深度> 1000 μm）CRC对ER后再行手术患者预后的影响。1992年2月至2019年6月期间在广岛大学医院接受ER后额外手术的215例T1b CRC连续患者被录取了我们评估了191例在额外手术中没有淋巴结转移的患者。根据垂直切缘距离将ER切除的标本分为3组：垂直切缘距离≥ 500 μm的患者（A组）、垂直切缘距离< 500 μm的患者（B组）和肿瘤垂直切缘阳性的患者（C组）。随后，我们评估了三组之间的临床病理特征的患者的预后。ResultsThere有三组之间的临床病理特征没有显着差异。A组5年无复发生存率显著高于B组和C组（分别为100%、84.5%和81.8%）。同样，A组有一个显着较高的疾病特异性5年生存率比C组（100%比95.5%）。结论完整的整块切除足够的粘膜下层从浸润前沿（垂直边缘距离> 500 μm）的T1结直肠癌减少额外的手术后转移复发的风险。
BackgroundVertical tumor margin-negative T1 colorectal carcinoma (CRC) is an absolute curative condition following complete endoscopic resection (ER). However, the influence on prognosis in relation to vertical tumor margin is unclear. Therefore, we evaluated the influence of the distance from vertical tumor margin to resected specimen edge (vertical margin distance) of ER for T1b (submucosal invasion depth > 1000 μm) CRC on the prognosis of patients undergoing additional surgery after ER.MethodsIn total, 215 consecutive patients with T1b CRC who underwent additional surgery after ER at Hiroshima University Hospital between February 1992 and June 2019 were enrolled. We assessed 191 patients without lymph node metastases at the additional surgery. The specimens resected by ER were classified into three groups based on the vertical margin distance: patients with a vertical margin distance of ≥ 500 μm (Group A); patients with a vertical margin distance of < 500 μm (Group B); and patients with a positive vertical tumor margin (Group C). Subsequently, we evaluated the prognosis of the patients in relation to the clinicopathological characteristics among the three groups.ResultsThere were no significant differences in clinicopathological characteristics among the three groups. Group A had a significantly higher recurrence-free 5-year survival rate than Groups B and C (100%, 84.5%, and 81.8%, respectively). Similarly, Group A had a significantly higher disease-specific 5-year survival rate than Group C (100% vs. 95.5%).ConclusionsComplete en bloc resection with sufficient submucosal layer from the invasive front (vertical margin distance > 500 μm) by ER for T1 CRC reduces the risk of metastatic recurrence after additional surgery.
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DOI：
10.1001/jama.1975.03240230053026
发表时间：
1975
期刊：
JAMA
影响因子：
--
作者：
R. Turnbull
通讯作者：
R. Turnbull
DOI：
10.1007/s004649900949
发表时间：
1999-03-01
期刊：
SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES
影响因子：
--
作者：
Kawamura, YJ;Sugamata, Y;Kawano, N
通讯作者：
Kawano, N
影响因子：
2.8
作者：
Asayama, Naoki;Oka, Shiro;Chayama, Kazuaki
通讯作者：
Chayama, Kazuaki
影响因子：
3.9
作者：
Kanemitsu, Yukihide;Komori, Koji;Kato, Tomoyuki
通讯作者：
Kato, Tomoyuki
影响因子：
6.3
作者：
Asayama, Naoki;Oka, Shiro;Chayama, Kazuaki
通讯作者：
Chayama, Kazuaki