Fujishiro Mitsuhiro, Yahagi Naohisa, Kakushima Naomi, Kodashima Shinya, Muraki Yosuke, Ono Satoshi, Yamamichi Nobutake, Tateishi Ayako, Oka Masashi, Ogura Keiji, Kawabe Takao, Ichinose Masao, Omata Masao
Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Clin Gastroenterol Hepatol. 2007 Jun;5(6):678-83; quiz 645. doi: 10.1016/j.cgh.2007.01.006. Epub 2007 Apr 26.
BACKGROUND & AIMS: The clinical outcomes for endoscopic submucosal dissection (ESD), a novel endoluminal surgery for gastrointestinal neoplasm in the colorectum, are reported.
ESD was performed on 186 consecutive patients with 200 colorectal epithelial neoplasms who had preoperative diagnoses of mucosal or slight submucosally invasive neoplasms. In addition, these could be of large size, with submucosal fibrosis, or located on an intestinal fold. The therapeutic efficacy and safety were assessed.
The targeted lesions consisted of 102 adenomas, 72 noninvasive carcinomas, and 26 invasive carcinomas. Seven lesions (3.5%) were histologically considered to be at substantial risk for nodal metastasis after ESD. The rate of en bloc resection was 91.5% (183/200), and en bloc resection with tumor-free lateral/basal margins (R0 resection) was 70.5% (141/200). Two lesions (1%) required emergency colonoscopies as a result of hematochezia after ESD. Eleven (5.5%) immediate perforations that occurred during ESD were successfully managed conservatively, but 1 (0.5%) delayed perforation required laparotomy. Two multiple-piece resections of 111 tumors (1.8%), which were successfully followed by colonoscopy (median follow-up, 18 months; range, 12-60 months), were found as locally recurrent tumors 2 and 21 months after ESD. No lymph node or distant metastasis was detected in 77 patients with noninvasive or invasive carcinoma (median follow-up, 24 months; range, 6-74 months).
ESD is applicable in the colorectum with promising results. However, when considering the risks and benefits, piecemeal endoscopic resection or colorectal resection might be more appropriate for some subgroups of large flat neoplasms or those with submucosal fibrosis.
报告了内镜黏膜下剥离术（ESD）这一用于结直肠胃肠道肿瘤的新型腔内手术的临床结果。
对186例连续的患者进行了ESD，这些患者有200个术前诊断为黏膜或轻度黏膜下浸润性肿瘤的结直肠上皮肿瘤。此外，这些肿瘤可能体积较大、伴有黏膜下纤维化或位于肠皱襞上。评估了治疗效果和安全性。
目标病变包括102个腺瘤、72个非浸润性癌和26个浸润性癌。7个病变（3.5%）在组织学上被认为ESD后有淋巴结转移的高风险。整块切除率为91.5%（183/200），切缘无肿瘤的整块切除（R0切除）率为70.5%（141/200）。2个病变（1%）因ESD后便血需要急诊结肠镜检查。ESD期间发生的1处（5.5%）即刻穿孔经保守治疗成功处理，但1处（0.5%）延迟穿孔需要开腹手术。111个肿瘤中有2处（1.8%）进行了多块切除，术后成功进行了结肠镜检查（中位随访时间18个月；范围12 - 60个月），在ESD后2个月和21个月发现为局部复发性肿瘤。77例非浸润性或浸润性癌患者未检测到淋巴结或远处转移（中位随访时间24个月；范围6 - 74个月）。
ESD适用于结直肠，效果良好。然而，在考虑风险和获益时，对于一些大的扁平肿瘤或伴有黏膜下纤维化的亚组患者，内镜分片切除或结直肠切除术可能更合适。
