Clinical outcomes of endoscopic submucosal dissection and endoscopic mucosal resection for laterally spreading tumors larger than 20 mm
Clinical outcomes of endoscopic submucosal dissection and endoscopic mucosal resection for laterally spreading tumors larger than 20 mm
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DOI：
10.1111/j.1440-1746.2011.06977.x
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发表时间：
2012-04-01
影响因子：
4.1
通讯作者：
Chayama, Kazuaki
中科院分区：
文献类型：
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作者：
Terasaki, Motomi;Tanaka, Shinji;Chayama, Kazuaki
背景和目的：结直肠侧向发育性肿瘤(LST；GT；20 mm)通常采用内窥镜黏膜下剥离术(ESD)或内窥镜黏膜切除术(EMR)治疗。有时需要内窥镜分段黏膜切除术(EPMR)。我们研究的目的是比较ESD和EMR(包括EPMR)治疗这类LST的结果。方法：从2006年4月到2009年12月，共有269例结直肠癌LST和GT；20例患者在该院接受内窥镜治疗。我们回顾评估了与ESD、混合型ESD(ESD+EMR)相关的并发症和局部复发率。结果：和178例EST的ESD和EMR均获得成功，其中ESD 61例，混合型ESD 28例，EMR 70例，FTWIR 108例。两组间穿孔率差异不显著。根治性切除的局部复发率：ESL为0%(0/56)，混合性ESD为0%(0/27)，EMR为1.4%(1/69)，EPMR为12.1%(13/107)，明显高于EPMR。随访时未见肿瘤转移。复发率高(P<；0.001)。结论：在安全性方面，ESD/混合PSI与EMR/EPMR具有同等的安全性。ESD/混合型ESL)是一种可行的整块切除技术，且无局部复发。虽然根据我们的适应症标准进行的EMR/EPMR相关的局部复发是可以看到的，但是所有的局部复发都可以通过附加的内窥镜治疗获得完全治愈。
Background and Aims: Colorectal laterally spreading tumors (LST) > 20 mm are usually treated by endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR). Endoscopic piecemeal mucosal resection (EPMR) is sometimes required. The aim of our study was to compare the outcomes of ESD and EMR, including EPMR, for such LST.Methods: A total of 269 consecutive patients with a colorectal LST > 20 nun were treated endoscopically at our hospital from April 2006 to December 2009. We retrospectively evaluated the complications and local recurrence rates associated with ESD, hybrid ESD (ESD with EMR). EMR, and EPMR.Results: ESD and EMR were performed successfully for 89 and 178 EST, respectively: 61 by ESD, 28 by hybrid ESD, 70 by EMR; and 108 by FTWIR. Between-group differences in perforation rates were not significant. Local recurrence rates in cases with curative resection were as follows: 0% (0/56) in ESL); 0% (0/27) in hybrid ESD; 1.4% (1/69) in EMR; and 12.1% (13/107) in EPMR; that is, significantly higher in EPMR. No metastasis was seen at follow up. The recurrence rate for EPMR yielding > three pieces was significantly high (P < 0.001). All 14 local recurrent lesions were adenomas that were cured endoscopically.Conclusions: As for safety, ESD/hybrid PSI) is equivalent to EMR/EPMR. ESD/hybrid ESL) is a feasible technique for en bloc resection and showed no local recurrence. Although local recurrences associated with EMR/EPMR were seen, which were conducted based on our indication criteria, all local recurrences could obtain complete cure by additional endoscopic treatment.