Deinlein P, Reulbach U, Stolte M, Vieth M
Institut für Pathologie, Klinikum Bayreuth, Bayreuth, Germany.
Pathologe. 2003 Sep;24(5):387-93. doi: 10.1007/s00292-003-0632-y.
During the last 20 years, endoscopic removal of colorectal adenoma has become widely accepted as a replacement for removal by open surgery. Even colorectal adenocarcinomas are not excluded. The key question is when surgical treatment should still be preferred over endoscopic removal as the primary treatment. One good indicator is the frequency of lymph node metastasis, which should be compared with the overall risk involved in the surgical procedure itself. Histological examination allows subdivision of early colorectal adenocarcinomas into low-risk and high-risk groups. Classical parameters for a high-risk situation are lymphatic invasion, poor differentiation, and incomplete removal (R1). Additional risk factors that have recently been discussed are infiltration into the lower third of the submucosal layer (sm3) and dissociation (budding) of the tumour cells at the invasion front. Drawing on the literature and an analysis of our own patients, we demonstrate a positive correlation between these new markers and an elevated risk of the presence of lymph node metastasis.
在过去20年中，内镜下切除结直肠腺瘤已被广泛接受，成为开放性手术切除的替代方法。甚至结直肠腺癌也不排除在内。关键问题是，何时手术治疗仍应优先于内镜切除作为主要治疗方法。一个很好的指标是淋巴结转移的频率，应将其与手术本身所涉及的总体风险进行比较。组织学检查可将早期结直肠腺癌分为低风险组和高风险组。高风险情况的经典参数是淋巴管浸润、低分化和切除不完全（R1）。最近讨论的其他风险因素是浸润至黏膜下层下三分之一（sm3）以及肿瘤细胞在浸润前沿的解离（芽生）。借鉴文献并分析我们自己的患者，我们证明了这些新标志物与淋巴结转移风险升高之间存在正相关。
