Togashi Kazutomo, Shimura Kunihiko, Konishi Fumio, Miyakura Yasuyuki, Koinuma Koji, Horie Hisanaga, Yasuda Yoshikazu
Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
Dis Colon Rectum. 2008 Feb;51(2):196-201. doi: 10.1007/s10350-007-9106-2. Epub 2008 Jan 3.
This study was designed to confirm the safety of not removing small adenoma in patients who undergo colorectal cancer surgery.
Patients who underwent surveillance colonoscopy after surgery were enrolled. The study was approved by our institutional review board. Colonoscopy was performed with magnification chromocolonoscopy. Benign adenomas of 6 mm or less in size, diagnosed based on both nonmagnified and magnified observation, were left unresected with a maximum of three polyps per patient. The sites of the polyps were marked by tattooing. Interval colonoscopy was performed predominantly yearly or biennially. Increase in size by 2 mm or larger was defined as significant. In follow-up, polyps were removed if they grew larger than 6 mm, were suspicious for high-grade dysplasia, or the patients requested to have polyps removal.
Five hundred polyps in 284 patients met the above criteria and were not resected, and 412 polyps were followed by repeat colonoscopy. The mean observation period was 3.6+/-2.2 years and the mean number of repeat colonoscopy was 3.6+/-1.6. At the final colonoscopy, 71 percent of 412 polyps showed no change in size, 15 percent increased, 3 percent decreased, and 11 percent could not be identified. Eighty-eight polyps were resected endoscopically, and histology showed neither cancer nor adenomas with high-grade dysplasia. Two hundred fifty-five polyps detected in the same patient cohort during index/repeat colonoscopy were removed, including four adenomas with high-grade dysplasia and two T1 cancers.
Leaving small polyps is safe even in patients who have undergone colorectal cancer surgery, provided that careful observation is guaranteed.
本研究旨在证实接受结直肠癌手术的患者中不切除小腺瘤的安全性。
纳入术后接受结肠镜监测的患者。本研究经机构审查委员会批准。采用放大色素结肠镜进行检查。根据非放大和放大观察诊断为大小在6毫米及以下的良性腺瘤不予以切除，每位患者最多保留3个息肉。通过纹身标记息肉部位。主要每年或每两年进行一次间隔结肠镜检查。息肉大小增加2毫米或更大被定义为有显著变化。在随访中，如果息肉生长超过6毫米、怀疑有高级别异型增生或患者要求切除息肉，则将其切除。
284例患者中的500个息肉符合上述标准未被切除，412个息肉接受了重复结肠镜检查。平均观察期为3.6±2.2年，平均重复结肠镜检查次数为3.6±1.6次。在最后一次结肠镜检查时，412个息肉中有71%大小无变化，15%增大，3%缩小，11%无法识别。88个息肉经内镜切除，组织学检查显示既无癌症也无高级别异型增生的腺瘤。在同一患者队列的初次/重复结肠镜检查中检测到的255个息肉被切除，包括4个高级别异型增生腺瘤和2个T1期癌症。
即使在接受结直肠癌手术的患者中，只要保证仔细观察，不切除小息肉也是安全的。
