Indications and outcomes of colorectal hybrid endoscopic submucosal dissection: a large multicenter 10-year study
Indications and outcomes of colorectal hybrid endoscopic submucosal dissection: a large multicenter 10-year study
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DOI：
10.1007/s00464-021-08471-5
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发表时间：
2021-04-13
影响因子：
3.1
通讯作者：
Chayama, Kazuaki
中科院分区：
文献类型：
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作者：
Okamoto, Yuki;Oka, Shiro;Chayama, Kazuaki
背景和目的混合式内窥镜下黏膜下剥离术(ESD)是一种包括计划和挽救两个步骤的结直肠病变切除手术。以前的结直肠癌混合可持续发展研究在短时间内涉及单一机构或少数运营商，指示的大小尚未确定。在这项多中心研究中，我们调查了混合式ESD对符合30 mm病变大小标准的结直肠肿瘤的临床结果。方法从2008年1月至2018年12月，在广岛胃肠内窥镜研究组对172个病灶(直径范围为20~30 mm)进行了结直肠混合ESD。我们比较了计划组和抢救组中分别有56个和116个病变的临床病理特征和结果。我们还比较了2008年和2013年(第一阶段)和2014年和2018年(第二阶段)的数据，以评估运营商的体验。结果保留组与计划组的完整切除率分别为92.9%和83.6%，差异无统计学意义(P>0.05)。计划组手术时间(44.5min)明显短于抢救组(72.0min，p<；0.01)。打捞组穿孔率(21.6%)高于计划组(0%)，但打捞组诱捕过程中穿孔率为1.8%。与第一阶段相比，第二阶段的完整切除率(95.7%比75.6%，p<；0.01)和有经验的操作率(分别为75.5%和53.9%，p<；0.01)明显更高。此外，在第二个时期内，计划组和保留组的完整肿瘤切除率(分别为100%和94.4%)无显著差异。结论结直肠混合型ESD，尤其是有经验的抢救性混合型ESD，适用于直径为20~30 mm的病变，安全可行。
Background and Aims Hybrid endoscopic submucosal dissection (ESD) is a colorectal lesion resection procedure that includes both planned and salvage procedures. Previous colorectal hybrid ESD studies have involved single institutions or few operators over a short timeframe, and the size for indication has not been established. In this multicentre study, we investigated the clinical outcomes of hybrid ESD for colorectal tumors that met the 30 mm lesion size criterion. Methods From January 2008 to December 2018, colorectal hybrid ESD was performed for 172 lesions (diameter range, >= 20- < 30 mm) at Hiroshima GI Endoscopy Research Group. We compared clinicopathological characteristics and outcomes between 56 and 116 lesions in planned and salvage groups, respectively. We also compared data between 2008 and 2013 (the first period) and 2014 and 2018 (the second period) to assess operator experience. Results No significant difference was found in the complete en bloc resection rate between the planned and salvage groups (92.9% vs. 83.6%, respectively). Procedure time was shorter in the planned group (44.5 min) than in the salvage group (72.0 min, p < 0.01). The perforation rate was higher in the salvage group (21.6%) than in the planned group (0%, p < 0.01); however, the perforation rate during snaring in the salvage group was 1.8%. During the second period relative to the first period, we recorded a significantly higher complete en bloc resection rate (95.7% vs. 75.6%, respectively, p < 0.01) and experienced operator rate (75.5% vs. 53.9%, respectively, p < 0.01). Furthermore, no significant difference was found in the complete en bloc resection rate between the planned and salvage groups during the second period (100% vs. 94.4%, respectively). Conclusion Colorectal hybrid ESD, especially salvage hybrid ESD performed by experienced operators, is adoptable and safe for lesions with diameters ranging from >= 20 to < 30 mm.